Emergency liver retransplantation for acute arterial thrombosis in a liver multi-transplanted patient: a case report

Liver retransplantation is a technically demanding procedure, particularly in patients with complex surgical histories and vascular complications such as hepatic artery thrombosis (HAT). We report the case of a 25-year-old woman who underwent a third liver transplant for graft cirrhosis. The procedure was technically demanding due to multiple adhesions, porta hepatic fibrosis, portal hypertension, and hypoplastic vasculature. Arterial reconstruction used an end-to-side anastomosis between the donor’s celiac trunk and the recipient’s splenic artery. On postoperative day 3, she underwent acute HAT and needed an urgent retransplantation (fourth liver). A new arterial anastomosis was created between the origin of the splenic artery and a Carrel patch from the donor’s celiac trunk. The patient made a full recovery. This case highlights the technical challenges of liver retransplantation and the importance of individualized vascular strategies.