Successful outcome after transplantation of a donor liver with focal nodular hyperplasia.
Because of the increasing gap in the number of patients awaiting organ transplantation and the supply of organ donors, reevaluation of donor criteria is an important issue in clinical transplantation. It has become necessary to make maximal use of the currently available donor pool. We describe a case of successful orthotopic liver transplantation in a 57-year-old man with Laënnec's cirrhosis using a liver containing an 8-cm focal nodular hyperplasia (FNH) lesion involving segments II and III and the caudate lobe. The donor liver was procured from a 46-year-old woman declared brain dead after a subarachnoid hemorrhage. Definitive pathological diagnosis was made at laparotomy by obtaining a Tru-cut (Allegiance Health Care Inc, Toronto, Ontario, Canada) core biopsy specimen. The recipient operation was performed uneventfully except for bleeding from the biopsy site. The patient did well postoperatively and was discharged on tacrolimus, mofetil mycophenolate, and prednisone therapy. He continues to thrive 2(1/2) years posttransplantation with no change in the size of the lesion. In well-selected donors, FNH should not be a contraindication for use in transplantation. However, FNH must be differentiated from hepatocellular adenoma. Although FNH has a benign course with little propensity for bleeding and almost no malignant potential, hepatic adenoma is reported to have a 15% to 33% chance of bleeding and rupture with a well-documented potential for neoplastic degeneration, making the liver unsuitable for donation.
Tan
M
M
Department of General Surgery, Section of Transplantation, McGill University Health Centre, Montreal, Quebec, Canada.
Di Carlo
A
A
Robinson
P
P
Tchervenkov
J I
JI
Barkun
J S
JS
Metrakos
P
P
D020518:Focal Nodular Hyperplasia / Q000000981:diagnostic imaging; D006801:Humans; D008103:Liver Cirrhosis / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D014019:Tissue Donors; D014057:Tomography, X-Ray Computed