Ewha Med J.  2016 Jul;39(3):76-80. 10.12771/emj.2016.39.3.76.

Living Donor Liver Transplantation in a Hepatitis B Patient with Acute on Chronic Liver Failure Accompanying Hepatocellular Carcinoma

• Hong HJ
• Lee JH
• Lee YB
• Park H
• Hwang SG
• Rim KS

• KMID: 2344895
• DOI: http://doi.org/10.12771/emj.2016.39.3.76

Abstract

Acute clinical deterioration in patients with chronic liver disease is called acute on chronic liver failure (ACLF). Principles of management of ACLF consist of early identifying etiology of liver disease, rapid intervention of precipitating event and discreet intensive cares. Despite medical intensive cares, if liver failure progresses, liver transplantation could be the other option. Also, liver transplantation is the only treatment that offers a chance of cure for hepatocellular carcinoma (HCC) and the underlying liver cirrhosis simultaneously. Emergent living donor liver transplantation (LDLT) can be performed for patients with acute liver failure and improves survival rate, especially in circumstances which liver graft is often not available because of deceased donors are not affordable. Here, we describe a chronic hepatitis B patient who developed ACLF accompanying early HCC. Because he did not improved with medical care, he received emergent LDLT. After LDLT, he showed great improvement without critical complications.

Keyword

Hepatocellular carcinoma; Chronic hepatitis B; Acute liver failure; Liver transplantation; Milan criteria

MeSH Terms

Acute-On-Chronic Liver Failure*
Carcinoma, Hepatocellular*
Hepatitis B*
Hepatitis B, Chronic
Hepatitis*
Humans
Liver Cirrhosis
Liver Diseases
Liver Failure
Liver Failure, Acute
Liver Transplantation*
Liver*
Living Donors*
Survival Rate
Tissue Donors
Transplants

Figure

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  Fig. 1 CT scans a hepatocellular carcinoma lesion in segment 7 is shown with arterial enhancement (A), and delayed wash-out of contrast (B).

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  Fig. 2 T2 weighted MR image. An 1.5 cm arterial enhancing hepatocellular carcinoma lesion (arrow) is shown in the segment 7 of liver.

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  Fig. 3 Histopathological findings of the liver. (A) Masson's trichrome stain reveals micro- and macronodular cirrhosis (×12). (B) Severe portoperiportal inflammation with frequent bile lakes is shown (H&E, ×100). (C) Lobules show degeneration with diffuse cholestasis (H&E, ×100). (D) Hepatocellular carcinoma is composed of thick trabeculae having marked nuclear atypia (H&E, ×100).

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  Fig. 4 Serial laboratory data of patient after hospitalization (ALT, alanine aminotransferase; T.Bilirubin, total bilirubin; HOD, hospital day).

Reference

1. Jalan R, Gines P, Olson JC, Mookerjee RP, Moreau R, Garcia-Tsao G, et al. Acute-on chronic liver failure. J Hepatol. 2012; 57:1336–1348.

2. Lim YS. Acute liver failure in Korea: etiology, prognosis and treatment. Korean J Hepatol. 2010; 16:5–18.

3. Kim DY, Kim HJ, Jeong SE, Kim SG, Kim HJ, Sinn DH, et al. The Korean guideline for hepatocellular carcinoma surveillance. J Korean Med Assoc. 2015; 58:385–397.

4. Song GW, Hwang S, Lee SG. Liver transplantation in patients with hepatocellular carcinoma. Korean J Gastroenterol. 2010; 55:350–360.

5. Lee KW, Suh KS. Liver transplantation for advanced hepatocellular carcinoma. J Korean Soc Transplant. 2010; 24:4–12.

6. Kim NY, Bae SH. Medical treatment of acute-on-chronic liver failure. In : The 19th Annual Meeting of The Korean Association for the Study of the Liver; 2013 Nov 21; Seoul, Korea. Seoul: The Korean Association for the Study of the Liver;2013. p. 277–282.

7. Yu S, Jianqin H, Wei W, Jianrong H, Yida Y, Jifang S, et al. The efficacy and safety of nucleos(t)ide analogues in the treatment of HBV-related acute-on-chronic liver failure: a meta-analysis. Ann Hepatol. 2013; 12:364–372.

8. Adam R, Del Gaudio M. Evolution of liver transplantation for hepatocellular carcinoma. J Hepatol. 2003; 39:888–895.

9. Mazzaferro V, Regalia E, Doci R, Andreola S, Pulvirenti A, Bozzetti F, et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med. 1996; 334:693–699.

10. Vitale A, Morales RR, Zanus G, Farinati F, Burra P, Angeli P, et al. Barcelona Clinic Liver Cancer staging and transplant survival benefit for patients with hepatocellular carcinoma: a multicentre, cohort study. Lancet Oncol. 2011; 12:654–662.