• Contact us
  • E-Submission

Ewha Med J : The Ewha Medical Journal

OPEN ACCESS
mobile search button mobile menu button
Search
Advanced Search
ABOUT
BROWSE ARTICLES
JOURNAL POLICIES
FOR CONTRIBUTORS

Articles

Page Path

Case Report

Living Donor Liver Transplantation in a Hepatitis B Patient with Acute on Chronic Liver Failure Accompanying Hepatocellular Carcinoma

Hee Jin Hong1, Joo Ho Lee1,2, Yun Bin Lee1,2, Hana Park1,2, Seong Gyu Hwang1,2, Kyu Sung Rim1,2
The Ewha Medical Journal 2016;39(3):76-80. Published online: July 29, 2016

1Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea.

2Division of Gastroenterology and Hepatology, Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea.

Corresponding author: Joo Ho Lee. Division of Gastroenterology and Hepatology, Department of Internal Medicine, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Bundang-gu, Seongnam 13496, Korea. Tel: 82-31-780-5212, Fax: 82-31-780-5219, piolee2000@naver.com
• Received: July 29, 2015   • Accepted: May 18, 2016

Copyright © 2016, The Ewha Medical Journal

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

  • 67 Views
  • 0 Download
  • 1 Crossref
prev next

Full Article

Download PDF Download PDF
  • Acute clinical deterioration in patients with chronic liver disease is called acute on chronic liver failure (ACLF). Principles of management of ACLF consist of early identifying etiology of liver disease, rapid intervention of precipitating event and discreet intensive cares. Despite medical intensive cares, if liver failure progresses, liver transplantation could be the other option. Also, liver transplantation is the only treatment that offers a chance of cure for hepatocellular carcinoma (HCC) and the underlying liver cirrhosis simultaneously. Emergent living donor liver transplantation (LDLT) can be performed for patients with acute liver failure and improves survival rate, especially in circumstances which liver graft is often not available because of deceased donors are not affordable. Here, we describe a chronic hepatitis B patient who developed ACLF accompanying early HCC. Because he did not improved with medical care, he received emergent LDLT. After LDLT, he showed great improvement without critical complications.
  • Keywords: Hepatocellular carcinoma; Chronic hepatitis B; Acute liver failure; Liver transplantation; Milan criteria
  • 1. Jalan R, Gines P, Olson JC, Mookerjee RP, Moreau R, Garcia-Tsao G, et al. Acute-on chronic liver failure. J Hepatol 2012;57:1336-1348.
  • 2. Lim YS. Acute liver failure in Korea: etiology, prognosis and treatment. Korean J Hepatol 2010;16:5-18.
  • 3. Kim DY, Kim HJ, Jeong SE, Kim SG, Kim HJ, Sinn DH, et al. The Korean guideline for hepatocellular carcinoma surveillance. J Korean Med Assoc 2015;58:385-397.
  • 4. Song GW, Hwang S, Lee SG. Liver transplantation in patients with hepatocellular carcinoma. Korean J Gastroenterol 2010;55:350-360.
  • 5. Lee KW, Suh KS. Liver transplantation for advanced hepatocellular carcinoma. J Korean Soc Transplant 2010;24:4-12.
  • 6. Kim NY, Bae SH. Medical treatment of acute-on-chronic liver failure In: The 19th Annual Meeting of The Korean Association for the Study of the Liver; 2013 Nov 21; Seoul, Korea. Seoul, The Korean Association for the Study of the Liver. 2013;pp 277-282.
  • 7. Yu S, Jianqin H, Wei W, Jianrong H, Yida Y, Jifang S, et al. The efficacy and safety of nucleos(t)ide analogues in the treatment of HBV-related acute-on-chronic liver failure: a meta-analysis. Ann Hepatol 2013;12:364-372.
  • 8. Adam R, Del Gaudio M. Evolution of liver transplantation for hepatocellular carcinoma. J Hepatol 2003;39:888-895.
  • 9. Mazzaferro V, Regalia E, Doci R, Andreola S, Pulvirenti A, Bozzetti F, et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med 1996;334:693-699.
  • 10. Vitale A, Morales RR, Zanus G, Farinati F, Burra P, Angeli P, et al. Barcelona Clinic Liver Cancer staging and transplant survival benefit for patients with hepatocellular carcinoma: a multicentre, cohort study. Lancet Oncol 2011;12:654-662.
Fig. 1

CT scans a hepatocellular carcinoma lesion in segment 7 is shown with arterial enhancement (A), and delayed wash-out of contrast (B).

emj-39-76-g001.jpg
Fig. 2

T2 weighted MR image. An 1.5 cm arterial enhancing hepatocellular carcinoma lesion (arrow) is shown in the segment 7 of liver.

emj-39-76-g002.jpg
Fig. 3

Histopathological findings of the liver. (A) Masson's trichrome stain reveals micro- and macronodular cirrhosis (×12). (B) Severe portoperiportal inflammation with frequent bile lakes is shown (H&E, ×100). (C) Lobules show degeneration with diffuse cholestasis (H&E, ×100). (D) Hepatocellular carcinoma is composed of thick trabeculae having marked nuclear atypia (H&E, ×100).

emj-39-76-g003.jpg
Fig. 4

Serial laboratory data of patient after hospitalization (ALT, alanine aminotransferase; T.Bilirubin, total bilirubin; HOD, hospital day).

emj-39-76-g004.jpg

Figure & Data

References

    Citations

    Citations to this article as recorded by  
    • Systematic review with meta‐analysis: liver transplant provides survival benefit in patients with acute on chronic liver failure
      Mohamed A. Abdallah, Muhammad Waleed, Matthew G. Bell, Morgan Nelson, Robert Wong, Vinay Sundaram, Ashwani K. Singal
      Alimentary Pharmacology & Therapeutics.2020; 52(2): 222.     CrossRef

    Download Citation

    Download a citation file in RIS format that can be imported by all major citation management software, including EndNote, ProCite, RefWorks, and Reference Manager.

    Format:

    Include:

    Living Donor Liver Transplantation in a Hepatitis B Patient with Acute on Chronic Liver Failure Accompanying Hepatocellular Carcinoma
    Ewha Med J. 2016;39(3):76-80.   Published online July 29, 2016
    DOI: https://doi.org/10.12771/emj.2016.39.3.76
    Download Citation
    Download a citation file in RIS format that can be imported by all major citation management software, including EndNote, ProCite, RefWorks, and Reference Manager.
    Format:
    • RIS — For EndNote, ProCite, RefWorks, and most other reference management software
    • BibTeX — For JabRef, BibDesk, and other BibTeX-specific software
    Include:
    • Citation for the content below
    Living Donor Liver Transplantation in a Hepatitis B Patient with Acute on Chronic Liver Failure Accompanying Hepatocellular Carcinoma
    Ewha Med J. 2016;39(3):76-80.   Published online July 29, 2016
    DOI: https://doi.org/10.12771/emj.2016.39.3.76
    Close

    Figure

    • 0
    • 1
    • 2
    • 3
    Living Donor Liver Transplantation in a Hepatitis B Patient with Acute on Chronic Liver Failure Accompanying Hepatocellular Carcinoma
    Image Image Image Image
    Fig. 1 CT scans a hepatocellular carcinoma lesion in segment 7 is shown with arterial enhancement (A), and delayed wash-out of contrast (B).
    Fig. 2 T2 weighted MR image. An 1.5 cm arterial enhancing hepatocellular carcinoma lesion (arrow) is shown in the segment 7 of liver.
    Fig. 3 Histopathological findings of the liver. (A) Masson's trichrome stain reveals micro- and macronodular cirrhosis (×12). (B) Severe portoperiportal inflammation with frequent bile lakes is shown (H&E, ×100). (C) Lobules show degeneration with diffuse cholestasis (H&E, ×100). (D) Hepatocellular carcinoma is composed of thick trabeculae having marked nuclear atypia (H&E, ×100).
    Fig. 4 Serial laboratory data of patient after hospitalization (ALT, alanine aminotransferase; T.Bilirubin, total bilirubin; HOD, hospital day).

    Fig. 1

    Fig. 2

    Fig. 3

    Fig. 4

    Living Donor Liver Transplantation in a Hepatitis B Patient with Acute on Chronic Liver Failure Accompanying Hepatocellular Carcinoma
    Ewha Med J : The Ewha Medical Journal

    ABOUT

    BROWSE ARTICLES 

    JOURNAL POLICIES

    FOR CONTRIBUTORS 

    © Ewha Womans University College of Medicine.
    TOP