Massive Polycystic Liver with a Poor Performance Status Successfully Treated by ABO-incompatible Adult Living-donor Liver Transplantation While Overcoming Complications

Abstract

We encountered a 47-year-old woman with polycystic liver disease (PLD) and severe malnutrition successfully treated by living-donor liver transplantation (LDLT). Her PLD became symptomatic with abdominal distension and appetite loss. Transcatheter arterial embolization and percutaneous cyst drainage failed to improve her symptoms. ABO-incompatible LDLT from her husband was performed after rituximab administration and mycophenolate mofetil introduction. Although she showed severe postoperative complications, she ultimately regained the ability to walk and was discharged. Because advanced PLD cases are difficult to treat conservatively or with surgery, like fenestration and hepatectomy, liver transplantation should be considered before it becomes too late.

En bloc excision of giant polycystic liver with hepatic cava and its auto‐transplant caval reconstruction as a safe surgical procedure for liver transplantation

“…The patient was discharged just over a month after surgery without any surgical complications and is now enjoying an active life that she had lost for 20 years. In this hereditary, refractory, but not uncommon disease, the larger and heavier the liver, the more difficult the surgery, the higher the intraoperative risks, 3,4 and the worse the patient’s quality of life that extends over decades 1–5 . Not only intraoperative bleeding but also long‐lasting malnutrition and resultant sarcopenia/frailty further deteriorate patient prognosis 2–5 .…”

“…In this hereditary, refractory, but not uncommon disease, the larger and heavier the liver, the more difficult the surgery, the higher the intraoperative risks, 3 , 4 and the worse the patient’s quality of life that extends over decades. 1 , 2 , 3 , 4 , 5 Not only intraoperative bleeding but also long‐lasting malnutrition and resultant sarcopenia/frailty further deteriorate patient prognosis. 2 , 3 , 4 , 5 LTx should be considered before it’s too late, for which this technique would facilitate safer LTx.…”

“… 1 , 2 , 3 , 4 , 5 Not only intraoperative bleeding but also long‐lasting malnutrition and resultant sarcopenia/frailty further deteriorate patient prognosis. 2 , 3 , 4 , 5 LTx should be considered before it’s too late, for which this technique would facilitate safer LTx.…”