Large Riedel's lobe and atrophic left liver in a donor - Accept for transplant or call off?

BACKGROUND: In context of suboptimal liver utilisation, grafts with various risk factors are under consideration today. For example, impaired vascularity with severe arterial calcifications and modified liver shapes are no longer contraindications and their use depends on the centre policy and experience of the surgical team. Riedel liver lobes represent a tongue-like liver shape with inferior projection in the right liver lobe. Such development modifications were initially described when patients developed a lesion and subsequently presented with symptoms. We here present the first case report in the literature, where such livers with anatomical variations were used for transplantation. CASE SUMMARY: We describe here two cases of adult human liver transplantation, where we have accepted two donor livers with modified shape. The technical considerations for transplantation of such livers, found with enlarged right lobes, or Riedel shape, and hypo-trophic left lateral segment are highlighted. Both recipients experienced immediate liver function and overall good outcomes with a minimum follow up of 1 year. We also provide detailed pictures and outcome analysis in combination with a literature review. CONCLUSION: The utilisation of donor livers with modified shape, such as Riedel's Lobe appears safe and will increase the donor pool.

Multidisciplinary insights into optimizing adherence after solid organ transplantation.

BACKGROUND: Nonadherence to medical treatment in transplant recipients is a major risk factor for graft rejection episodes, and it has significant financial implications. Despite its importance, there is a lack of common understanding across the disciplines involved of the key issues driving nonadherence. METHODS: A qualitative study, comprising a multidisciplinary workshop, followed by a consultation exercise to validate its outcomes, was initiated to gain further insight into nonadherence behavior and to identify priorities for optimizing adherence to posttransplantation regimens. RESULTS: Eight statements relating to actions necessary to maximize adherence to posttransplantation medication were developed and offered for validation. All but one of these attracted a median score of 9 on an agreement scale of 1 to 10, where 10 was the highest level of agreement. CONCLUSION: The outcomes generate a structure that will facilitate communication and understanding and informing clinical practice and future research.