Living Donor Liver Transplant as Rescue Surgery for a Patient with Hepatocellular Carcinoma Who Underwent Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS)
Unusual clinical course, Challenging differential diagnosis, Unusual or unexpected effect of treatment
Eduardo de Souza Martins Fernandes, Felipe Pedreira Tavares de Mello, Ronaldo Oliveira Andrade, Camila Liberato Girao, Leandro Savattone Pimentel, Camilla Cesar, Claudia Cristina Sousa, Anderson Brito-Azevedo, Samanta Teixeira Basto, Orlando Jorge Martins Torres
Department of Gastrointestinal and Liver Transplant Surgery, Rio de Janeiro Adventista Hospital, Rio de Janeiro, RJ, Brazil
Am J Case Rep 2018; 19:1338-1341
The associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is an important tool to induce fast liver hypertrophy. The degree of hepatic fibrosis/cirrhosis in patients with HCC negatively impacts their health, and the risk of liver failure is always present. In these cases, liver transplantation may be necessary as a rescue procedure. We present the case of a patient with HCC who underwent ALPPS and developed liver failure. A living donor liver transplant was performed as a rescue procedure.
CASE REPORT: A 49-year-old man with chronic hepatitis B without cirrhosis underwent computed tomography, which revealed an expansive lesion in the right lobe of his liver that was diagnosed as hepatocellular carcinoma. Liver resection was indicated and liver cirrhosis was observed with high portal pressure after transection. The treatment strategy was switched from right hepatectomy to ALPPS. The patient developed severe liver dysfunction and liver transplantation was indicated. His postoperative course was uneventful and 3 months after the procedure the patient was without complications.
CONCLUSIONS: Living donor liver transplantation may be necessary as a rescue procedure for patients who underwent ALPPS and develop liver dysfunction.
Keywords: Hepatectomy, Liver Cirrhosis, Alcoholic, Liver Failure, Acute, Liver Transplantation