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World J Hepatol. 2017 Dec 28;9(36):1361-1366. doi: 10.4254/wjh.v9.i36.1361.

De-novo hepatocellular carcinoma after pediatric living donor liver transplantation.

Author information

1
Department of Gastrointestinal Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, United States.
2
Department of Surgery, Yale University School of Medicine, New Haven, CT 06510, United States.
3
Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, NY 10021, United States.
4
Department of Pathology, Royal Columbian Hospital, New Westminster, British Columbia V3L 3W7, Canada.
5
Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT 06510, United States.
6
Department of Surgery, Yale University School of Medicine, New Haven, CT 06510, United States. rodriguezmi@me.com.
7
Division of Digestive Diseases and Transplant and Immunology, Department of Medicine and Surgery, Yale University School of Medicine, New Haven, CT 06510, United States.

Abstract

De-novo malignancies carry an incidence ranging between 3%-26% after transplant and account for the second highest cause of post-transplant mortality behind cardiovascular disease. While the majority of de-novo malignancies after transplant usually consist of skin cancers, there has been an increasing rate of solid tumor cancers over the last 15 years. Although, recurrence of hepatocellular carcinoma (HCC) is well understood among patients transplanted for HCC, there are increasing reports of de-novo HCC in those transplanted for a non-HCC indication. The proposed pathophysiology for these cases has been mainly connected to the presence of advanced graft fibrosis or cirrhosis and always associated with the presence of hepatitis B or C virus. We report the first known case of de-novo HCC in a recipient, 14 years after a pediatric living related donor liver transplantation for end-stage liver disease due to biliary atresia without the presence of hepatitis B or C virus before and after transplant. We present this case report to increase the awareness of this phenomenon and address on the utility for screening and surveillance of hepatocellular carcinoma among these individuals. One recommendation is to use similar guidelines for screening, diagnosis, and treatment for HCC as those used for primary HCC in the pre-transplant patient, focusing on those recipients who have advanced fibrosis in the allograft, regardless of etiology.

KEYWORDS:

Biliary atresia; De-novo hepatocellular carcinoma; Liver transplantation; Living donor liver transplantation

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