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DOI: 10.1055/a-2214-1712
Living-Donor Liver Transplantation for a Large Hepatocellular Carcinoma in a Genetically Identical Twin Sister
Leber-Lebendspende bei genetisch identischen Zwillingsschwestern bei großem Hepatozellulärem KarzinomThis 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.
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.
Schlüsselwörter
Hepatozelluläres Karzinom - Lebertransplantation - Zwillinge - eineiig - Lebertransplantation eines LebendspendersPublikationsverlauf
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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