Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Dec 24, 2015; 5(4): 354-359
Published online Dec 24, 2015. doi: 10.5500/wjt.v5.i4.354
Orthotopic liver transplantation for giant liver haemangioma: A case report
Undine G Lange, Julian N Bucher, Markus B Schoenberg, Christian Benzing, Moritz Schmelzle, Tanja Gradistanac, Steffen Strocka, Hans-Michael Hau, Michael Bartels
Undine G Lange, Christian Benzing, Hans-Michael Hau, Michael Bartels, Department of Visceral, Transplant, Thoracic and Vascular Surgery, Leipzig University Hospital, 04103 Leipzig, Germany
Julian N Bucher, Markus B Schoenberg, Department for General, Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital Munich, Ludwig-Maximilian-University, 04989 Munich, Germany
Moritz Schmelzle, Department of General, Visceral and Transplant Surgery, Berlin University Hospital, 10115 Berlin, Germany
Tanja Gradistanac, Institute for Pathology, Leipzig University Hospital, 04103 Leipzig, Germany
Steffen Strocka, Department of Diagnostic and Interventional Radiology, Leipzig University Hospital, 04103 Leipzig, Germany
Author contributions: Lange UG, Bucher JN and Schoenberg MB collected the data and wrote the report; Benzing C, Schmelzle M and Bartels M reviewed the report; Gradistanac T performed the pathological analyses; Strocka S performed the radiologic analyses; Hau HM designed the report.
Institutional review board statement: This study was reviewed and approved by the University of Leipzig Institutional Review Board.
Informed consent statement: All study participants, or their legal guardians, provided informed verbal consent prior to study enrolment.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Undine G Lange, MD, Department of Visceral, Transplant, Thoracic and Vascular Surgery, Leipzig University Hospital, Liebigstraße 20, 04103 Leipzig, Germany. undinegabriele.lange@medizin.uni-leipzig.de
Telephone: +49-341-9719173 Fax: +49-341-9717209
Received: May 6, 2015
Peer-review started: May 8, 2015
First decision: June 9, 2015
Revised: October 4, 2015
Accepted: November 17, 2015
Article in press: November 25, 2015
Published online: December 24, 2015
Processing time: 231 Days and 3.5 Hours
Abstract

In liver haemangiomas, the risk of complication rises with increasing size, and treatment can be obligatory. Here we present a case of a 46-year-old female who suffered from a giant haemangioma causing severe portal hypertension and vena cava compression, leading to therapy refractory ascites, hyponatremia and venostasis-associated thrombosis with pulmonary embolism. The patients did not experience tumour rupture or consumptive coagulopathy. Surgical resection was impossible because of steatosis of the non-affected liver. Orthotopic liver transplantation was identified as the only treatment option. The patient’s renal function remained stable even though progressive morbidity and organ allocation were improbable according to the patient’s lab model for end-stage liver disease (labMELD) score. Therefore, non-standard exception status was approved by the European organ allocation network “Eurotransplant”. The patient underwent successful orthotopic liver transplantation 16 mo after admission to our centre. Our case report indicates the underrepresentation of morbidity associated with refractory ascites in the labMELD-based transplant allocation system, and it indicates the necessity of promptly applying for non-standard exception status to enable transplantation in patients with a severe clinical condition but low labMELD score. Our case highlights the fact that liver transplantation should be considered early in patients with non-resectable, symptomatic benign liver tumours.

Keywords: Giant haemangioma; Therapy refractory ascites; Orthotopic liver transplantation; Non-standard exception status; Lab model for end-stage liver disease -based allocation system

Core tip: Here, we present a case of a 46-year-old woman with a giant, symptomatic, non-resectable haemangioma of the liver. The patient suffered from recurrent ascites and malnutrition. The patient finally received a liver transplant 16 mo following her initial presentation after being granted non-standard exception status. This case clearly indicates that liver transplantation must be considered early in patients with non-resectable, symptomatic benign liver tumours. Furthermore, it highlights the necessity of applying for non-standard exception status to enable transplantation in patients with a severe clinical condition but low labMELD score.