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

Ger Koek; Sophia M. Schmitz; Jan Bednarsch; Daniel Heise; Thomas Longerich; Frank Bakers; Christian Trautwein; Tom Luedde; Tom Florian Ulmer; Ulf Peter Neumann

doi:10.1055/a-2214-1712

Zeitschrift für Gastroenterologie, Table of Contents

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

¹Department of Internal Medicine, Division of Gastroenterology/Hepatology, Maastricht UMC+, Maastricht, Netherlands (Ringgold ID: RIN199236)

,

Sophia M. Schmitz

²General-, Visceral and Transplantation Surgery, Universitätsklinikum Essen, Essen, Germany (Ringgold ID: RIN39081)

³General-, Visceral and Transplantation Surgery, University Hospital RWTH Aachen, Aachen, Germany (Ringgold ID: RIN39058)

,

Jan Bednarsch

²General-, Visceral and Transplantation Surgery, Universitätsklinikum Essen, Essen, Germany (Ringgold ID: RIN39081)

³General-, Visceral and Transplantation Surgery, University Hospital RWTH Aachen, Aachen, Germany (Ringgold ID: RIN39058)

,

Daniel Heise

²General-, Visceral and Transplantation Surgery, Universitätsklinikum Essen, Essen, Germany (Ringgold ID: RIN39081)

⁴General-, Visceral and Transplantation Surgery, University Hospital RWTH Aachen, Aachen, Germany

,

Thomas Longerich

⁵Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany

,

Frank Bakers

⁶Department of Radiology, Maastricht UMC+, Maastricht, Netherlands (Ringgold ID: RIN199236)

,

Christian Trautwein

⁷Department of Gastroenterology Metabolic Disorders and Internal Intensive Medicine, University Hospital RWTH Aachen, Aachen, Germany

,

Tom Luedde

⁸Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Duesseldorf, Duesseldorf, Germany

,

Tom Florian Ulmer

²General-, Visceral and Transplantation Surgery, Universitätsklinikum Essen, Essen, Germany (Ringgold ID: RIN39081)

³General-, Visceral and Transplantation Surgery, University Hospital RWTH Aachen, Aachen, Germany (Ringgold ID: RIN39058)

⁹Department of Surgery, Maastricht UMC+, Maastricht, Netherlands (Ringgold ID: RIN9165)

,

Ulf Peter Neumann

²General-, Visceral and Transplantation Surgery, Universitätsklinikum Essen, Essen, Germany (Ringgold ID: RIN39081)

³General-, Visceral and Transplantation Surgery, University Hospital RWTH Aachen, Aachen, Germany (Ringgold ID: RIN39058)

⁹Department of Surgery, Maastricht UMC+, Maastricht, Netherlands (Ringgold ID: RIN9165)

› Author Affiliations

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

Full Text

References

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