Original contributions: Case reports in transplantation
Liver
Salvage Living-Donor Liver Transplantation for Liver Failure Following Definitive Radiation Therapy for Recurrent Hepatocellular Carcinoma: A Case Report

https://doi.org/10.1016/j.transproceed.2015.02.011Get rights and content

Highlights

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    Taking care of radiation-induced vessel complications in LDLT patients is necessary.

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    Radiation-induced vessel injury typically develops as a late complication.

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    The strategy of salvage LDLT was effective even after multidisciplinary treatment.

Abstract

A 57-year-old man with a history of hepatitis B virus infection was referred to our hospital for living-donor liver transplantation (LDLT). Five years earlier, right lobectomy had been performed for solitary hepatocellular carcinoma (HCC) with bile duct tumor thrombus in segments 5 and 6 in the liver. Two years later, transarterial chemoembolization and radiofrequency ablation were performed for recurrent HCC. Two years after those local therapies, another recurrent HCC was treated with transhepatic arterial infusion chemotherapy with cisplatin and conventional radiation therapy (RT) with 60 Gy in 20 fractions, because the tumor was contiguous to the trunk of the portal vein. After the completion of RT, symptoms due to liver failure and severe infection caused by multiple liver abscesses developed despite the administration of antibiotics and percutaneous transhepatic cholangiodrainage. Therefore, LDLT was performed with the use of a right lobe graft donated by his wife. Vascular anastomosis was successfully performed with the use of normal procedures. The patient recovered uneventfully, and has since been doing well for 34 months, with no evidence of vascular complications. However, the degree of injury to the anastomotic vessels caused by definitive RT before LDLT remains unclear, whereas the safety and efficacy of some forms of RT as a bridge to deceased-donor LT have been reported. Salvage LDLT is effective for patients with liver failure after multidisciplinary treatment including radiation, while carefully taking radiation-induced vessel injury as a potential late complication into consideration, especially in LDLT cases.

Section snippets

Case Report

A 57-year-old Japanese man with a history of chronic hepatitis B virus infection who developed liver failure after multidisciplinary treatment for recurrent HCC was referred to our hospital to undergo LDLT. Five years earlier, contrast-enhanced computerized tomography (CT) detected the presence of solitary HCC, which measured 20 mm in size, with bile duct tumor thrombus in segments 5 and 6 in the liver, and right lobectomy was therefore performed. Two years later, transarterial

Discussion

LT is now theoretically the optimal curative treatment for patients with HCC, because it removes the tumor radically as well as the underlying oncogenic liver disease [6]. However, a shortage of donor organs and dropping out from the waiting list because of tumor progression are still the biggest problems associated with DDLT for HCC. In an effort to reduce the number of patients who drop out during the waiting period, various strategies have evolved over the past 2 decades as bridging

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