Journal List > Ewha Med J > v.39(3) > 1058679

TOOLS
Hong, Lee, Lee, Park, Hwang, and Rim: Living Donor Liver Transplantation in a Hepatitis B Patient with Acute on Chronic Liver Failure Accompanying Hepatocellular Carcinoma
Case Report

The Ewha Medical Journal 2016; 39(3): 76-80.

Published online: 29 July 2016

DOI: https://doi.org/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

Hee Jin Hong1, Joo Ho Lee1, 2, Yun Bin Lee1, 2, Hana Park1, 2, Seong Gyu Hwang1, 2, Kyu Sung Rim1, 2

1Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea.

2Division of Gastroenterology and Hepatology, Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea.

Corresponding author: Joo Ho Lee. Division of Gastroenterology and Hepatology, Department of Internal Medicine, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Bundang-gu, Seongnam 13496, Korea. Tel: 82-31-780-5212, Fax: 82-31-780-5219, piolee2000@naver.com

Received 29 July 2015       Accepted 18 May 2016

Copyright © 2016, The Ewha Medical Journal

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Hepatocellular carcinoma, Chronic hepatitis B, Acute liver failure, Liver transplantation, Milan criteria

Figures and Tables

Fig. 1

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

emj-39-76-g001
Fig. 2

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

emj-39-76-g002
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).

emj-39-76-g003
Fig. 4

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

emj-39-76-g004

References

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.
TOOLS
Similar articles