Korean J Transplant.  2023 Nov;37(Suppl 1):S189. 10.4285/ATW2023.F-7742.

Late hepatocellular carcinoma recurrence after living donor liver transplantation: unmet need

• Montesser IF
• Ebada H
• Bahaa M
• Massoud Y
• Sakr M
• Dabbous H
• Saleh M
• Meteini ME

• KMID: 2551809
• DOI: http://doi.org/10.4285/ATW2023.F-7742

Abstract

A 50-year-old male patient at time of transplantation he received living donor liver transplantation for hepatocellular carcinoma (HCC) on top of hepatitis C virus (HCV) cirrhosis in March 2015 and had quite smooth operative and postoperative course. He had two sessions of transcatheter arterial chemoembolization before transplantation as down staging and the explant pathology showed partial tumor necrosis and moderately differentiated HCC with no vascular or capsular invasion single nodule in segment VIII with multiple viable nodules in the vicinity. Patient received direct acting antivirals after 3 months of transplantation for HCV in the form of sofosbuvir/daclatsvir and achieved sustained virologic response. Since then, he was on regular follow up liver functions, alpha-fetoprotein (AFP) and ultrasound every 3–6 months. In April 2022 he has rising trend of AFP (25-30-35 ng/dL) serially which was repeated in 1 month. Ultrasound showed homogeneous graft with no focal lesions so we decided to do positron emission tomography/computed tomography (PET/CT) that revealed left suprarenal mass 3×3 cm (maximum standardized uptake value, 5.8) and no other hepatic or extra hepatic metastasis. The patient underwent left adrenal excision, and the diagnosis of HCC recurrence was confirmed by histopathology of the excised mass. He received 3 months of Nexaver which was stopped because of intolerance to side effects and kept on low dose tacrolimus and mammalian target of rapamycin with follow up PET scan and AFP after 3 months then every 6 months and he is quite well with HCC recurrence free till now (last AFP in June 2023 was 1.5 ng/dL and FK trough level 2). We hereby report a case of late HCC recurrence after 7 years of transplantation that was early diagnosed through strict HCC surveillance protocol as per unit protocol.