Giant polycystic liver disease with thoracic involvement: An anaesthesia and surgical challenge in liver transplantation.

Polycystic liver disease is a rare inherited disorder that is usually associated with autosomal dominant polycystic kidney disease. Advanced forms of the disease can cause massive hepatomegaly, chest compression, and severe respiratory compromise. We present the case of a 46-year-old woman with hepatorenal polycystic disease who developed progressive dyspnoea, early satiety, and abdominal distension despite treatment with lanreotide. The CT scan revealed a liver measuring 14,200 cc, partial lung collapse, and mediastinal displacement. Given the risk of thoracic compression, an orthotopic liver transplant was performed using a sterno-laparotomy approach and femoro-portal veno-venous bypass to achieve haemodynamic stability during the anhepatic phase. The evolution was favourable, and the patient was discharged on day 11 and re-assessed at 6 months without incident. This case highlights the importance of multidisciplinary planning and the selective use of veno-venous bypass to ensure safe anaesthesia and surgical management in giant polycystic liver disease.