*Purpose: Situs Inversus Totalis (SIT) is a rare condition affecting 0.1% of the general population. It was historically a contraindication for LTx and graft donation. Some LTx techniques have been described for SIT recipients and grafts, but no consensus into which is the most appropriate. Here we present our LTx techniques for SIT grafts and recipients and a review of the literature (Table 1-2).

*Methods: A 21 year old man with SIT and PSC underwent LTx with a graft from a conventional donor. We used a 45° clockwise rotation of the graft and end-to-side caval anastomosis (Fig. 1). A 61 year old recipient with HCC and normal anatomy was transplanted with a left-sided liver from a SIT donor. We used a 30° counterclockwise rotation and a piggy-back anastomosis (Fig. 2). The hepatic artery and biliary duct were reconstructed in an end-to-end fashion in both cases.

*Results: The postoperative course of the recipient with SIT was characterized by minor complications (SSI and rejection). The 61 year old patient receiving a whole SIT graft had an uneventful recovery. Both patients are alive, with a follow up of 24 and 36 months, respectively.

*Conclusions: Thorough preoperative evaluation and imaging is a cornerstone in the management of LTx in SIT. Our two techniques are simple and effective, with optimal results without extreme changes in the surgical technique and without the use of venous grafts.

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