Rescue Living-donor Liver Transplantation for Liver Failure Following Hepatectomy for Hepatocellular Carcinoma

Abstract

Liver failure following major hepatectomy for hepatocellular carcinoma is a known but uncommon mode of early treatment failure. When post-hepatectomy liver failure becomes progressive, the only effective treatment for rescuing the patient is liver transplantation. Deceased-donor liver transplantation in this situation is often not feasible because of the shortage of deceased-donor liver grafts. Proceeding with living-donor liver transplantation is an ethical challenge because of the possibility of donor coercion. In addition, tumor status, as confirmed by histopathological examination of the resected specimen, may indicate aggressive cancer that warns against rescue transplantation because of the increased chance of tumor recurrence. Here we describe four cases of rescue living-donor liver transplantation for liver failure after hepatectomy for hepatocellular carcinoma. The patients all survived the transplantation and were free from tumor recurrence after follow-up periods ranging from 6 months to 9 years. Our experience has shown that rescue living-donor liver transplantation for post-hepatectomy liver failure is feasible. Tumor status should be considered carefully because large tumors and tumors with macrovascular invasion are strong contraindications to rescue living-donor liver transplantation.

Treatment of Hepatocellular Carcinoma with Child-Pugh C Cirrhosis

“…Recommended therapies for these patients include best supportive care from major treatment algorithms determined by the Japan Society of Hepatology [1], the American Association for the Study of Liver Diseases, and the European Association for the Study of the Liver [2,3]. Liver transplantation [4,5,6,7,8] could be an alternative therapy when patients are younger than 65 years and the HCC is within the Milan criteria in the Japanese guidelines [9]. However, since the majority of HCC patients are older than 65 years and a shortage of donors has been a consistent problem in Japan, many patients instead receive locoregional therapies [10,11] in clinical settings.…”

Real-Life Clinical Practice with Sorafenib in Advanced Hepatocellular Carcinoma: A Single-Center Experience Second Analysis

“…Because most patients are diagnosed with advanced disease stages, only 30% of patients receive potentially curative therapies, such as surgical resection [2,3,4], transplantation [5,6,7,8] or percutaneous ablation [9,10,11,12,13]. A majority of patients with unresectable HCC usually undergo palliative treatments, such as transarterial chemoembolization (TACE) [14,15,16], hepatic arterial infusion chemotherapy (HAIC) [17] and systemic chemotherapy, including therapy using molecular targeted agents [17,18,19,20].…”

Emerging Strategies for the Management of Hepatocellular Carcinoma

“…On the morning of the second day, four topics were discussed at the ‘Early Morning Breakfast Workshop': (1) ‘Surgical Treatment', (2) ‘Liver Transplantation' [13,17,18,19,20], (3) ‘Carcinogenesis, Genomics, Pathways, and Targets', and (4) ‘Radiation Therapy' [21,22]. An intensive and extremely valuable discussion was conducted by specialists in the respective fields.…”