From Donor Liver to Recipient Pulmonary Artery: Embolization of a Transected Central Venous Catheter During Liver Transplantation, A Rare Complication of Organ Procurement

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Central venous catheters (CVCs) are essential in transplantation but can rarely fracture and embolize, with donor-to-recipient transmission of catheter fragments scarcely described. A 62-year-old woman with hepatitis C-related cirrhosis and hepatocellular carcinoma underwent orthotopic liver transplantation from a brain-dead donor with a left subclavian multi-lumen CVC in situ at procurement. Postoperative chest radiography identified a new curvilinear opacity at the left hilum, and contrast-enhanced computed tomography showed a 5 cm radiopaque structure in a segmental branch of the left lower lobe pulmonary artery, consistent with an embolized CVC tip. All recipient vascular access devices were removed intact, strongly suggesting a donor-origin catheter fragment transplanted with the liver graft. Alternative explanations, including unrecognized recipient catheter fracture and pre-existing foreign body, were considered but deemed less likely given the temporal relationship, imaging findings, and systematic device inspection. Percutaneous endovascular retrieval via femoral venous access was attempted but failed because of the fragment's distal location and probable endothelialization. Therapeutic anticoagulation was considered but not commenced because there was no radiological evidence of thrombus formation or pulmonary embolism, and substantial competing postoperative bleeding risk. The patient remained asymptomatic, and conservative management with clinical and imaging surveillance was adopted; at 6 months, she had excellent graft function and no cardiopulmonary sequelae. However, an uneventful short-term follow-up does not establish long-term safety, and early retrieval remains the preferred strategy whenever technically feasible and clinically safe. This case represents, to our knowledge, a previously unreported mechanism of donor-to-recipient CVC fragment transmission in liver transplantation, with the most plausible explanation being unrecognized transection of the donor catheter during heart procurement with subsequent lodgment in hepatic venous outflow, although definitive proof is not possible in the absence of direct intraoperative recognition. It highlights an important systems-level vulnerability at the interface between donor procurement, graft preparation, and recipient implantation. Modern multiorgan retrieval frequently involves multiple independent procedural teams, overlapping operative fields, and rapid transitions, creating fragmented responsibility for confirming removal and integrity of vascular access devices. This case underscores the importance of standardized vascular access reconciliation, careful inspection of donor venous structures, and early postoperative imaging. Structured vascular access reconciliation and verification protocols, analogous to surgical instrument counts and implant verification systems, may represent an important patient-safety intervention in transplantation.

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