Two cases of salvage liver transplantation for the HCC presented initial advanced stage beyond UCSF criteria and shown good prognosis.

Abstract

Introduction: We tried LDLT for two patients who have advanced HCC. Method: Case 1. A 46-year-old male patient who has chronic hepatitis B carrier were developed a 6cm-sized tumor in left lateral section with tumor thrombus in left portal vein and elevated α-FP and PIVKA II level. He underwent left hepatectomy with tumor thrombectomy and pathologic report showed moderately differentiated HCC invaded to portal vein and bile duct. Two years after surgery, two metastatic pulmonary nodules appeared and were removed by wedge resection. He had stable liver function and no recurrence or metastasis until 9 years after surgery. However, the liver was decompensated cirrhosis with intractable ascites without HCC recurrence for the late 2 years. So, living donor liver transplantation was performed at eleven and half years after initial hepatectomy. The patient recovered completely without any complication after LDLT and has been received of immunosuppression with combination of low dose tacrolimus and everolimus. Case 2. A 56-year old male patient who has chronic hepatitis B carrier developed 10cm sized HCC in his hepatic segment 5-6 combined with portal vein tumor thrombosis. The patient was undergone right hemihepatectomy. The pathology showed moderately differentiated HCC with partial infiltrating type and portal vein tumor thrombosis in the hepatic segment 5&6. Multiple intrahepatic metastasis was developed in the remnant left liver including caudate lobe 4 months after surgical resection. The patient underwent TACE followed by living donor liver transplantation 6 months after initial resection. The patient received immunosuppression with low dose prograf and everolimus daily. Result: The first patient has been doing well his works without tumor recurrence until one and half year after liver transplantation. For the second patient, there was no evidence of recurrence until twenty months after transplantation. Conclusion: Salvage liver transplantation for the HCC presented initial advanced stage beyond UCSF criteria is feasible selectively.