Ann Liver Transplant.  2023 May;3(1):23-28. 10.52604/alt.23.0005.

Seven-year survival after peritoneal metastasis of hepatocellular carcinoma occurring 12 years after living donor liver transplantation

• Kim MJ
• Hwang S
• Song GW
• Moon DB
• Jung DH
• Ahn CS
• Ha TY
• Park GC

• KMID: 2560918
• DOI: http://doi.org/10.52604/alt.23.0005

Abstract

Very late recurrence of hepatocellular carcinoma (HCC) after liver transplantation is rare. We herein present a case of peritoneal metastasis of HCC occurring 12 years after living-donor LT (LDLT), and surviving 7 years after HCC recurrence. A 65-yearold male patient who had undergone LDLT 12 years earlier showed marginally elevated tumor marker levels on regular outpatient follow-up. After observation for 3 months, follow-up studies revealed a peritoneal seeding mass. Thorough imaging studies revealed that the mass was highly likely to be metastatic HCC. Two mass lesions were excised, and the patient was administered low-dose calcineurin inhibitor, sirolimus, and full-dose sorafenib. Subsequently, the tumor marker levels increased again and growth of new peritoneal seeding nodules was observed; therefore, sorafenib was stopped after 2 years of administration. Immunosuppressive regimen was switched to everolimus monotherapy. During 7 years after HCC recurrence, the patient had experienced very slow progression of recurrent HCC, permitting good maintenance of quality of life. He died from far advanced HCC at the age of 72 years, at 19 years after LDLT. For very late peritoneal metastasis of HCC, aggressive multi-modality therapeutic treatment appears to be effective to prolong overall patient survival.

Keyword

Hepatocellular carcinoma; Recurrence; Metastasis; Everolimus; Resection

Figure

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  Figure 1 Serial measurement of tumor marker levels before and during 7 years after metastasectomy. AFP, alpha-fetoprotein.

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  Figure 2 Computed tomography taken at 12 years after transplantation showing a pelvis mass (arrow).

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  Figure 3 Positron emission tomography showing a hypermetabolic-uptake mass at the pelvis (arrow).

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  Figure 4 Follow-up computed tomography images showing progressive growth of the recurrent masses at 4 years (A), 5 years (B), 6 years (C), and 7 years (D) after metastasectomy (arrows).

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  Figure 5 Gross image of the resected metastatic pelvis mass with very narrow tumor-negative resection margins.

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  Figure 6 Follow-up computed tomography (A) and positron emission tomography (B) images taken at 6 months after metastasectomy showing recurrent multiple lesions (arrows).

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