Korean J Transplant.  2021 Oct;35(Supple 1):S155. 10.4285/ATW2021.OP-1242.

Pancreaticoduodenectomy for de novo ampulla of Vater cancer 15 years after living donor liver transplantation: a case report

• Hwang S
• Na BG
• Kim SM
• Yang G

• KMID: 2521320
• DOI: http://doi.org/10.4285/ATW2021.OP-1242

Abstract

Background
De novo malignancy sporadically occurs in patients who undergo liver transplantation. We present a case of a 74-year-old patient who underwent pancreaticoduodenectomy (PD) for de novo ampulla of Vater cancer at 15 years after living donor liver transplantation (LDLT) for hepatitis B virus-associated liver cirrhosis.
Case report
At 15 years after LDLT, elevation of liver enzyme levels led to diagnosis of de novo ampulla of Vater mass. We performed pylorus-resecting PD with extended pancreatic transection. Roux-en-Y choledochojejunostomy was performed to the remnant recipient-side proximal bile duct because active back bleeding from the bile duct stump was identified. The patient recovered uneventfully without complications. The surgical specimen showed a 2 cm-sized moderately differentiated adenocarcinoma arising from a tubular adenoma of the intestinal subtype at the ampulla of Vater. The extent of the tumor was pT1bN0M0, thus being stage IB. Adjuvant chemotherapy was not performed. The patient has been doing well for 3 months. The immunosuppressive regimen was switched from mycophenolate mofetil monotherapy to everolimus monotherapy.
Conclusions
Our experience with this case suggests that PD can be eligibly performed after LDLT using duct-to-duct anastomosis.