Living Donor Liver Re-Transplantation for Recurrent Hepatoblastoma in the Liver Graft following Complete Eradication of Peritoneal Metastases under Indocyanine Green Fluorescence Imaging

Abstract

The curability of chemotherapy-resistant hepatoblastoma (HB) largely depends on the achievement of radical surgical resection. Navigation techniques utilizing indocyanine green (ICG) are a powerful tool for detecting small metastatic lesions. We herein report a patient who underwent a second living donor liver transplantation (LDLTx) for multiple recurrent HBs in the liver graft following metastasectomy for peritoneal dissemination with ICG navigation. The patient initially presented with ruptured HB at 6 years of age and underwent 3 liver resections followed by the first LDLTx with multiple sessions of chemotherapy at 11 years of age. His alpha-fetoprotein (AFP) level increased above the normal limit, and metastases were noted in the transplanted liver and peritoneum four years after the first LDLTx. The patient underwent metastasectomy of the peritoneally disseminated HBs with ICG navigation followed by the second LDLTx for multiple metastases in the transplanted liver. The patient has been recurrence-free with a normal AFP for 30 months since the second LDLTx. To our knowledge, this report is the first successful case of re-LDLTx for recurrent HBs. Re-LDLTx for recurrent HB can be performed in highly select patients, and ICG navigation is a powerful surgical tool for achieving tumor clearance.

Anti-Cancer Effects of 3, 3’-Diindolylmethane on Human Hepatocellular Carcinoma Cells Is Enhanced by Calcium Ionophore: The Role of Cytosolic Ca2+ and p38 MAPK

“…Two human HCC cell lines (SMMC-7721 and HepG2) were purchased from Shanghai Institute of Cell Bank (Shanghai, China). Both cell lines express alpha fetoprotein (AFP) protein (Liu et al, 2018; Qin et al, 2019), an established marker of liver cancer (Dezso et al, 2019; Takahashi et al, 2019), though notably SMMC-7721 is a HeLa derived cell line. The cells were grown as adherent monolayers in DMEM supplemented with 10% FBS (Thermo Fisher Scientific, WI, USA), 100 U/mL penicillin, and 100 μg/mL streptomycin.…”

Laparoscopic Partial Splenectomy Assisted by Fluorescence in a 13-Year-Old Girl

“…It is contraindicated in those allergic to iodinated contrasts or with thyroid disorders. 9,[11][12][13][14] The use of fluorescence in surgery is emerging, but experience in splenic pathology is very limited. Kawasaki et al 15 used ICG during distal pancreatectomies with splenic preservation.…”

“…It is contraindicated in those allergic to iodinated contrasts or with thyroid disorders. 9 11 12 13 14 …”

Fluorescence-Guided Surgery for Hepatoblastoma with Indocyanine Green

“…In such situations, ICG should be given around 72–96 h prior to the operation in order to minimize nonspecific fluorescence. For example, ICG was administered 72 h before resection for peritoneal dissemination in patient 8, as shown in Figure 6a–d [44], and for metastases to the pleura and diaphragm in patient 20, as shown in Figure 7a–c [33]. In these cases, fluorescence-guided surgery greatly helped surgeons identify the exact location and extent of the tumor even in a dense, adhesive operative field.…”

“… a – d : Multiple metastatic HBs in the transplanted liver in vivo ( a , b ) and ex vivo ( c , d ). This patient underwent the second living donor liver transplantation [44]. …”