Multidisciplinary approach to the treatment of a patient with hepatocellular carcinoma against the background of liver cirrhosis of viral (hepatitis C) etiology. Cinical case

Abstract

The article presents a clinical case of a multidisciplinary approach to the treatment of 55‑years‑old patient with hepatocellular carcinoma (HCC) against the background of liver cirrhosis of viral (hepatitis C) etiology. A focal liver lesion was accidentally detected during an ultrasound examination in an asymptomatic patient. Further radiological studies (CT and MRI of the liver with contrast) revealed numerous focal lesions of the liver against the background of its cirrhotic alterations. One of the foci in S7 with dimensions 62x68 mm, had LIRADS 5 signs, so it did not require histological verification. According to the Barcelona guidelines, the patient met criteria for advanced HCC (stage B). Treatment options in this case were liver transplantation or locoregional therapy to reduce the HCC stage. The preserved portal blood flow and the preserved functional status of the patient made it possible to conduct successful transarterial chemoembolisation of the focus in S7. After two months, radiological control recorded stabilization of the focus with necrosis and absence of distant metastatic lesions. Moreover, patient had a recurrence of viral hepatitis C, which required administration of the scheme sofosbuvir + glecaprevir/pibrentasvir. After reviewing the patient’s clinical status and evaluating his radiological and serological dynamics, the possibility of liver transplantation was considered. On April 20, 2023, a successful orthotopic liver transplantation was performed. Pathomorphological findings confirmed HCC G2 in the S7 focus. Three months after transplantation, the patient developed a clinical picture of acute cellular rejection of mild severity, which was confirmed by pathomorphological examination. Appropriate correction of immunosuppressive therapy stabilized the patient’s clinical condition and liver function tests. In the future, the patient needs dynamic monitoring with careful control of laboratory parameters and radiological examinations.