Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 26, 2019; 7(18): 2794-2801
Published online Sep 26, 2019. doi: 10.12998/wjcc.v7.i18.2794
Liver re-transplantation for donor-derived neuroendocrine tumor: A case report
Anna Mrzljak, Branislav Kocman, Anita Skrtic, Ivana Furac, Jelena Popic, Lucija Franusic, Renata Zunec, Davor Mayer, Danko Mikulic
Anna Mrzljak, Department of Medicine, Merkur University Hospital, School of Medicine, University of Zagreb, Zagreb 10000, Croatia
Branislav Kocman, Danko Mikulic, Department of Surgery, Merkur University Hospital, Zagreb 10000, Croatia
Anita Skrtic, Department of Pathology and Cytology, Merkur University Hospital, School of Medicine, University of Zagreb, Zagreb 10000, Croatia
Ivana Furac, DNA Laboratory, Institute of Forensic Medicine and Criminalistics, School of Medicine, University of Zagreb, Zagreb 10000, Croatia
Jelena Popic, Department of Radiology, Merkur University Hospital, School of Medicine, University of Zagreb, Zagreb 10000, Croatia
Lucija Franusic, School of Medicine, University of Zagreb, Zagreb 10000, Croatia
Renata Zunec, Department for Tissue Typing, Clinical Hospital Centre Zagreb, Zagreb 10000, Croatia
Davor Mayer, Institute of Forensic Medicine and Criminalistics, School of Medicine, University of Zagreb, Zagreb 10000, Croatia
Author contributions: Mrzljak A and Franusic L made contributions to the conception and design of the study, acquisition of the data, and drafting of the manuscript; Kocman B was the patient’s surgeon; Skrtic A and Popic J analyzed and interpreted the imaging findings; Furac I and Mayer D were involved in genetic analysis; Zunec R was involved in acquisition of donor data; Mikulic D made contributions to the study design and was involved in critically revising the manuscript; All authors read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2013), and the manuscript was prepared and revised according to the CARE Checklist (2016).
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/
Corresponding author: Anna Mrzljak, MD, PhD, Assistant Professor, Department of Medicine, Merkur University Hospital, School of Medicine, University of Zagreb, Salata 3b, Zajceva 19, Zagreb 10000, Croatia. anna.mrzljak@mef.hr
Telephone: +385-1-2431016
Received: June 19, 2019
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
Abstract
BACKGROUND

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).

CASE SUMMARY

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.

CONCLUSION

The benefits of graft explantation should be weighed against the risks of re-LT and the likelihood of NEN dissemination beyond the graft.

Keywords: Donor-origin tumor, Neuroendocrine tumor, Liver transplantation, Donor, Case report

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.