Medical Problems Causing the Cancellation of Liver Transplantation

Abstract

Liver transplants have become an established method for treating decompensated liver cirrhosis in recent years. However, as the number of liver transplants increases, there are many cases in which transplantation is judged to be too difficult, such as with malignant tumors or other organ dysfunction. Here, we review the medical problems of three potential liver transplant recipients for whom transplantation was canceled based on pre- or intraoperative examinations. Case 1 was a 54-year-old female with idiopathic portal hypertension and decompensated liver cirrhosis due to hepatitis C virus, complicated by breast cancer. She underwent surgery for the breast cancer, but the pathology determined that she was in a high-risk group, with lymph node metastasis; the staging was T2 N1 Mo Stage IIb with ly(+), V(+), and HER2 positivity, requiring follow-up studies. Case 2 was a 58-year-old male suffering from primary sclerosing cholangitis. Preoperatively, the patient developed repeated strictures of the bile duct, and cytology and a biopsy were performed. FDG-PET examination was also performed, but identification of the cancer proved difficult. An intraoperative biopsy discovered cancer from the gall bladder to the common bile duct, and the operation was halted. Case 3 was a 43-year-old male with decompensated liver cirrhosis due to hepatitis B virus combined with pulmonary hypertension. Vascular catheterization showed an average pulmonary arterial pressure of 56 mmHg, so epoprostenol sodium was administered. However, this treatment was minimally efficacious, and the surgery was cancelled. When considering liver transplants, it is necessary to take into account the progress of any liver cirrhosis, and the possibility that it may be accompanied by intrahepatic cancer or cancers of other internal organs. It will be necessary to establish standards for liver transplantation following the radical treatment of malignant tumors. To evaluate the deterioration in liver function accompanied by the related dysfunction of other organs, patients should undergo periodic examinations by medical specialists.