Ann Hepatobiliary Pancreat Surg.  2024 Nov;28(4):516-521. 10.14701/ahbps.24-101.

Liver transplantation for organ failure following multiple locoregional treatments for breast cancer metastasis

• Berardi G
• Giannelli V
• Colasanti M
• Cianni R
• Meniconi R
• Guglielmo N
• Ferretti S
• Cesare LD
• Pellicelli A
• Ventroni G
• Cortesi E
• Ettorre GM

• KMID: 2561585
• DOI: http://doi.org/10.14701/ahbps.24-101

Abstract

Patients with nonresectable breast cancer liver metastasis (BCLM) face a dismal prognosis. Despite liver transplantation (LT) for metastatic liver tumors having recently shown good results, BCLM represents an absolute contraindication. This study aimed to investigate the potential for long-term survival after LT for BCLMs in a patient experiencing end-stage liver disease, following multiple oncologic treatments. In July 2019, we performed a deceased donor LT on a 41-year-old female with BCLM controlled with human epidermal growth factor receptor 2 targeted therapy, who developed liver failure following multiple locoregional liver-directed treatments. The primary tumor was treated with surgical resection and adjuvant chemoradiation in 2000. The procedure was performed under a protocol approved by the local ethical committee, and by the Italian National Transplant Center. A 12-month treatment with trastuzumab was performed immediately after LT. Immunosuppression following transplantation was undertaken without steroids, and with everolimus. The patient completed 12 months of follow-up without recurrence. Trastuzumab was then withdrawn. Fifteen months after LT, a liver recurrence occurred that was treated with chemotherapy. In October 2021, she developed 2 brain lesions that were treated with stereotactic radiation. The patient is still alive, with a positron emission tomography/computed tomography performed in January 2024 showing no disease. LT for this patient with BCLM of extreme selectivity showed a good clinical outcome. Perioperative systemic treatment and tumor control are necessary. A specific protocol should be discussed within a multidisciplinary team, and with local and national authorities. Even if tumor recurrence occurs, multimodal therapy can control the disease.

Keyword

Breast cancer; Liver metastasis; Liver transplantation; Transarterial radioembolization; Transarterial chemoembolization

Figure

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  Fig. 1 Presentation of the metastatic disease of the liver in 2008.

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  Fig. 2 Explanted liver after transplantation.

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  Fig. 3 Magnetic resonance imaging showing multifocal recurrence in the transplanted liver.

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  Fig. 4 Computed tomograpy scan at last follow-up (January 2024), 54 months after transplantation, showing complete response after systemic treatment.

Reference

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