Published online Sep 26, 2019. doi: 10.12998/wjcc.v7.i18.2794
Peer-review started: June 26, 2019
First decision: August 1, 2019
Revised: August 5, 2019
Accepted: August 20, 2019
Article in press: August 20, 2019
Published online: September 26, 2019
Donor-origin cancer is a well-recognized but rare complication after liver transplantation (LT). The rise in the use of extended criteria donors due to the current shortage of organs increases the risk. Data on donor-origin neuroendocrine neoplasms (NENs) and the most appropriate treatment are scarce. Here, we report a case of a patient who developed a NEN confined to the liver after LT and was treated with liver re-transplantation (re-LT).
A 49-year-old man with no other medical co-morbidities underwent LT in 2013 for alcoholic liver cirrhosis. The donor was a 73-year-old female with no known malignancies. Early after LT, a hypoechogenic (15 mm) lesion was detected in the left hepatic lobe on abdominal ultrasound. The lesion was stable for next 11 mo, when abdominal magnetic resonance identified two hypovascular lesions (20 and 11 mm) with atypical enhancement pattern. Follow-up abdominal ultrasound revealed no new lesions for the next 2.5 years, when magnetic resonance showed a progression in size and number of lesions, also confirmed by abdominal computed tomography. Liver biopsy proved a well-differentiated NEN. Genetic analysis of the NEN confirmed donor origin of the neoplasm. As NEN was confined to liver graft only, in 2018, the patient underwent his second LT. At 12 mo after re-LT the patient is well with no signs of NEN dissemination.
The benefits of graft explantation should be weighed against the risks of re-LT and the likelihood of NEN dissemination beyond the graft.
Core tip: Donor-origin neuroendocrine neoplasm is a rare but well-recognized complication after liver transplantation. The management is individualized and liver re-transplantation may be considered a long-term treatment option. However, the benefits of graft explantation should be weighed against the risks of liver re-transplantation and the likelihood of neuroendocrine neoplasm dissemination beyond the graft.