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CC BY-NC-ND 4.0 · Z Gastroenterol 2024; 62(01): 56-61
DOI: 10.1055/a-2214-1712
Kasuistik

Living-Donor Liver Transplantation for a Large Hepatocellular Carcinoma in a Genetically Identical Twin Sister

Leber-Lebendspende bei genetisch identischen Zwillingsschwestern bei großem Hepatozellulärem Karzinom
Ger Koek
1   Department of Internal Medicine, Division of Gastroenterology/Hepatology, Maastricht UMC+, Maastricht, Netherlands (Ringgold ID: RIN199236)
,
Sophia M. Schmitz 
2   General-, Visceral and Transplantation Surgery, Universitätsklinikum Essen, Essen, Germany (Ringgold ID: RIN39081)
3   General-, Visceral and Transplantation Surgery, University Hospital RWTH Aachen, Aachen, Germany (Ringgold ID: RIN39058)
,
Jan Bednarsch
2   General-, Visceral and Transplantation Surgery, Universitätsklinikum Essen, Essen, Germany (Ringgold ID: RIN39081)
3   General-, Visceral and Transplantation Surgery, University Hospital RWTH Aachen, Aachen, Germany (Ringgold ID: RIN39058)
,
Daniel Heise
2   General-, Visceral and Transplantation Surgery, Universitätsklinikum Essen, Essen, Germany (Ringgold ID: RIN39081)
4   General-, Visceral and Transplantation Surgery, University Hospital RWTH Aachen, Aachen, Germany
,
Thomas Longerich
5   Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
,
Frank Bakers
6   Department of Radiology, Maastricht UMC+, Maastricht, Netherlands (Ringgold ID: RIN199236)
,
Christian Trautwein
7   Department of Gastroenterology Metabolic Disorders and Internal Intensive Medicine, University Hospital RWTH Aachen, Aachen, Germany
,
Tom Luedde 
8   Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Duesseldorf, Duesseldorf, Germany
,
Tom Florian Ulmer
2   General-, Visceral and Transplantation Surgery, Universitätsklinikum Essen, Essen, Germany (Ringgold ID: RIN39081)
3   General-, Visceral and Transplantation Surgery, University Hospital RWTH Aachen, Aachen, Germany (Ringgold ID: RIN39058)
9   Department of Surgery, Maastricht UMC+, Maastricht, Netherlands (Ringgold ID: RIN9165)
,
Ulf Peter Neumann
2   General-, Visceral and Transplantation Surgery, Universitätsklinikum Essen, Essen, Germany (Ringgold ID: RIN39081)
3   General-, Visceral and Transplantation Surgery, University Hospital RWTH Aachen, Aachen, Germany (Ringgold ID: RIN39058)
9   Department of Surgery, Maastricht UMC+, Maastricht, Netherlands (Ringgold ID: RIN9165)
› InstitutsangabenThis work was supported by TKI-LSH (grant no. 40-41200-98-9306 to G. H. Koek). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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Abstract

Hepatocellular carcinoma (HCC) is, to date, the most common malignant tumor of the liver and is commonly staged with the Milan criteria. While deceased-donor liver transplantations (DDLT) are reserved for patients within the Milan criteria, living-donor liver transplantation (LDLT) might be a curative option for patients outside the Milan criteria. We here report a case of a 32-year-old woman who developed a giant, unresectable HCC out of a hepatocellular adenoma (HCA) after a pregnancy. The genetically identical twin sister donated her left hemi-liver after ethical approval and preoperative screening. No long-term immunosuppressive therapy was necessary, and after more than eight years, both are in perfect health and the recipient gave birth to a second child. This case shows that in certain situations large HCCs outside the standard criteria can be cured by LT. Careful evaluation of both donor and recipient should be performed for indications like this to assure optimal clinical outcome.

Zusammenfassung

Das Hepatozelluläre Karzinom (HCC) ist der häufigste bösartige Tumor der Leber und wird häufig anhand der Mailänder Kriterien klassifiziert. Lebertransplantationen verstorbener Spender (DDLT) sind Patienten vorbehalten, die sich innerhalb der Mailänder Kriterien befinden. Für Patienten außerhalb der Mailänder Kriterien können Lebertransplantation durch einen Lebendspender (LDLT) eine therapeutische Option sein. Diese Studie berichtet über den Fall einer 32-jährigen Frau, die nach einer Schwangerschaft ein riesiges, inoperables HCC aus einem hepatozellulären Adenom (HCA) entwickelte. Die genetisch identische Zwillingsschwester spendete nach ethischer Genehmigung und präoperativem Screening ihre linke Leberhälfte. Eine langfristige immunsuppressive Therapie war nicht erforderlich. Mehr als acht Jahre nach der Transplantation sind beide Schwestern gesundheitlich in exzellentem Zustand und die Empfängerin brachte kürzlich ein zweites Kind zur Welt. Dieser Fall zeigt, dass in bestimmten Situationen große HCCs außerhalb der Mailänder Kriterien durch Leber-Lebendspenden geheilt werden können. Bei solchen Indikationen muss eine sorgfältige Beurteilung sowohl des Spenders als auch des Empfängers durchgeführt werden, um ein optimales klinisches Ergebnis sicherzustellen.

Keywords

hepatocellular carcinoma - liver transplantation - twins - monozygotic - living donor

Schlüsselwörter

Hepatozelluläres Karzinom - Lebertransplantation - Zwillinge - eineiig - Lebertransplantation eines Lebendspenders


Publikationsverlauf

Eingereicht: 31. August 2023

Artikel online veröffentlicht:
09. Januar 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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  • References

  • 1 Rooks JB, Ory HW, Ishak KG. et al. Epidemiology of hepatocellular adenoma. The role of oral contraceptive use. JAMA 1979; 242 (07) 644-648 (PMID: 221698)
    CrossrefPubMedGoogle Scholar
  • 2 Gaspersz MP, Klompenhouwer AJ, Broker MEE. et al. Growth of hepatocellular adenoma during pregnancy: A prospective study. J Hepatol 2020; 72 (01) 119-124
    CrossrefPubMedGoogle Scholar
  • 3 van Aalten SM, Broker ME, Busschbach JJ. et al. Pregnancy and liver adenoma management: PALM-study. BMC gastroenterology 2012; 12: 82 DOI: 10.1186/1471-230X-12-82. (PMID: 22748109)
    CrossrefPubMedGoogle Scholar
  • 4 Aziz H, Brown ZJ, Eskander MF. et al. A Scoping Review of the Classification, Diagnosis, and Management of Hepatic Adenomas. J Gastrointest Surg 2022; 26 (04) 965-978 DOI: 10.1007/s11605-022-05246-8. (PMID: 35083725)
    CrossrefPubMedGoogle Scholar
  • 5 Nault JC, Couchy G, Balabaud C. et al. Molecular Classification of Hepatocellular Adenoma Associates With Risk Factors, Bleeding, and Malignant Transformation. Gastroenterology 2017; 152 (04) 880-894 e6
    CrossrefPubMedGoogle Scholar
  • 6 Bioulac-Sage P, Laumonier H, Couchy G. et al. Hepatocellular adenoma management and phenotypic classification: the Bordeaux experience. Hepatology 2009; 50 (02) 481-489 DOI: 10.1002/hep.22995. (PMID: 19585623)
    CrossrefPubMedGoogle Scholar
  • 7 Abdel-Hamid NM, Abouzied MM, Nazmy MH. et al. A suggested guiding panel of seromarkers for efficient discrimination between primary and secondary human hepatocarcinoma. Tumour Biol 2016; 37 (02) 2539-2546 DOI: 10.1007/s13277-015-4025-7..
    CrossrefPubMedGoogle Scholar
  • 8 Sempoux C, Gouw ASH, Dunet V. et al. Predictive Patterns of Glutamine Synthetase Immunohistochemical Staining in CTNNB1-mutated Hepatocellular Adenomas. Am J Surg Pathol 2021; 45 (04) 477-487 DOI: 10.1097/PAS.0000000000001675. (PMID: 33560657)
    CrossrefPubMedGoogle Scholar
  • 9 Mazzaferro V, Regalia E, Doci R. et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. The New England journal of medicine 1996; 334 (11) 693-699
    CrossrefPubMedGoogle Scholar
  • 10 Bruix J, Sherman M. American Association for the Study of Liver D. Management of hepatocellular carcinoma: an update. Hepatology 2011; 53 (03) 1020-1022
    CrossrefPubMedGoogle Scholar
  • 11 Lee JY, Kim YH, Yi NJ. et al. Impact of immunosuppressant therapy on early recurrence of hepatocellular carcinoma after liver transplantation. Clin Mol Hepatol 2014; 20 (02) 192-203 DOI: 10.3350/cmh.2014.20.2.192. (PMID: 25032186)
    CrossrefPubMedGoogle Scholar
  • 12 Hemming AW, Cattral MS, Reed AI. et al. Liver transplantation for hepatocellular carcinoma. Ann Surg 2001; 233 (05) 652-659 DOI: 10.1097/00000658-200105000-00009. (PMID: 11323504)
    CrossrefPubMedGoogle Scholar
  • 13 Todo S, Furukawa H, Japanese Study Group on Organ T. Living donor liver transplantation for adult patients with hepatocellular carcinoma: experience in Japan. Ann Surg 2004; 240 (03) 451-459
    CrossrefPubMedGoogle Scholar
  • 14 Lei JY, Wang WT, Yan LN. “Metroticket” predictor for assessing liver transplantation to treat hepatocellular carcinoma: a single-center analysis in mainland China. World journal of gastroenterology 2013; 19 (44) 8093-8098 DOI: 10.3748/wjg.v19.i44.8093. (PMID: 24307805)
    CrossrefPubMedGoogle Scholar
  • 15 Halazun KJ, Tabrizian P, Najjar M. et al. Is it Time to Abandon the Milan Criteria?: Results of a Bicoastal US Collaboration to Redefine Hepatocellular Carcinoma Liver Transplantation Selection Policies. Ann Surg 2018; 268 (04) 690-699 DOI: 10.1097/SLA.0000000000002964. (PMID: 30048307)
    CrossrefPubMedGoogle Scholar
  • 16 Lei JY, Wang WT, Yan LN. Up-to-seven criteria for hepatocellular carcinoma liver transplantation: a single center analysis. World journal of gastroenterology 2013; 19 (36) 6077-6083 DOI: 10.3748/wjg.v19.i36.6077. (PMID: 24106409)
    CrossrefPubMedGoogle Scholar
  • 17 Duffy JP, Vardanian A, Benjamin E. et al. Liver transplantation criteria for hepatocellular carcinoma should be expanded: a 22-year experience with 467 patients at UCLA. Ann Surg 2007; 246 (03) 502-509
    CrossrefPubMedGoogle Scholar
  • 18 Lozanovski VJ, Ramouz A, Aminizadeh E. et al. Prognostic role of selection criteria for liver transplantation in patients with hepatocellular carcinoma: a network meta-analysis. BJS Open 2022; 6 (01) zrab130 DOI: 10.1093/bjsopen/zrab130..
    CrossrefPubMedGoogle Scholar
  • 19 Yao FY, Ferrell L, Bass NM. et al. Liver transplantation for hepatocellular carcinoma: expansion of the tumor size limits does not adversely impact survival. Hepatology 2001; 33 (06) 1394-1403
    CrossrefPubMedGoogle Scholar
  • 20 de Ataide EC, Garcia M, Mattosinho TJ. et al. Predicting survival after liver transplantation using up-to-seven criteria in patients with hepatocellular carcinoma. Transplant Proc 2012; 44 (08) 2438-2440
    CrossrefPubMedGoogle Scholar
  • 21 Mazzaferro V, Llovet JM, Miceli R. et al. Predicting survival after liver transplantation in patients with hepatocellular carcinoma beyond the Milan criteria: a retrospective, exploratory analysis. Lancet Oncol 2009; 10 (01) 35-43
    CrossrefPubMedGoogle Scholar
  • 22 Sapisochin G, Goldaracena N, Laurence JM. et al. The extended Toronto criteria for liver transplantation in patients with hepatocellular carcinoma: A prospective validation study. Hepatology 2016; 64 (06) 2077-2088
    CrossrefPubMedGoogle Scholar
  • 23 Ivanics T, Claasen MP, Samstein B. et al. Living Donor Liver Transplantation (LDLT) for Hepatocellular Carcinoma (HCC) within and Outside Traditional Selection Criteria: A Multicentric North American Experience. Ann Surg 2023; DOI: 10.1097/SLA.0000000000006049..
    CrossrefPubMedGoogle Scholar
  • 24 Bhangui P, Saigal S, Gautam D. et al. Incorporating Tumor Biology to Predict Hepatocellular Carcinoma Recurrence in Patients Undergoing Living Donor Liver Transplantation Using Expanded Selection Criteria. Liver Transpl 2021; 27 (02) 209-221 DOI: 10.1002/lt.25956. (PMID: 33253492)
    CrossrefPubMedGoogle Scholar
  • 25 Lee S, Song GW, Kim KW. et al. Living Donor Liver Transplantation Versus Deceased Donor Liver Transplantation for Hepatocellular Carcinoma Within or Beyond the Milan Criteria: Comparable Long-Term Outcomes. Transplant Proc 2021; 53 (01) 92-97 DOI: 10.1016/j.transproceed.2020.10.012. (PMID: 33288309)
    CrossrefPubMedGoogle Scholar
  • 26 Vivarelli M, Cucchetti A, La Barba G. et al. Liver transplantation for hepatocellular carcinoma under calcineurin inhibitors: reassessment of risk factors for tumor recurrence. Ann Surg 2008; 248 (05) 857-862 DOI: 10.1097/SLA.0b013e3181896278. (PMID: 18948815)
    CrossrefPubMedGoogle Scholar
  • 27 Yoshizawa A, Takada Y, Fujimoto Y. et al. Liver transplantation from an identical twin without immunosuppression, with early recurrence of hepatitis C. Am J Transplant 2006; 6 (11) 2812-2816
    CrossrefPubMedGoogle Scholar
  • 28 Liu LU, Schiano TD, Min AD. et al. Syngeneic living-donor liver transplantation without the use of immunosuppression. Gastroenterology 2002; 123 (04) 1341-1345
    CrossrefPubMedGoogle Scholar
  • 29 van Aalten SM, Witjes CD, de Man RA. et al. Can a decision-making model be justified in the management of hepatocellular adenoma?. Liver Int 2012; 32 (01) 28-37 DOI: 10.1111/j.1478-3231.2011.02667.x. (PMID: 22098685)
    CrossrefPubMedGoogle Scholar
  • 30 Cobey FC, Salem RR. A review of liver masses in pregnancy and a proposed algorithm for their diagnosis and management. Am J Surg 2004; 187 (02) 181-191
    CrossrefPubMedGoogle Scholar
  • 31 Noels JE, van Aalten SM, van der Windt DJ. et al. Management of hepatocellular adenoma during pregnancy. J Hepatol 2011; 54 (03) 553-558
    CrossrefPubMedGoogle Scholar