Combined adult-to-adult living donor right lobe liver transplantation and pancreatoduodenectomy for distal bile duct adenocarcinoma in a patient with primary sclerosing cholangitis.
BACKGROUND
Liver transplantation is the best therapeutic option for patients with end-stage liver disease from primary sclerosing cholangitis. Primary sclerosing cholangitis is associated with a markedly increased risk of cholangiocarcinoma, which adversely affects survival. Approximately 20% to 30% of cholangiocarcinomas are localized in the distal bile duct. Pancreatoduodenectomy is the curative therapy for cholangiocarcinomas in this location.


METHODS
We reviewed our data on a patient with primary sclerosing cholangitis-related end-stage liver disease and a simultaneous distal bile duct tumor, which was treated with a combined right-lobe, living-donor liver transplantation and pancreatoduodenectomy.


RESULTS
The patient was discharged 32 days post-transplantation. He is currently alive 1 year after the procedure with no evidence of recurrent cancer.


CONCLUSIONS
Combined living-donor liver transplantation and pancreatoduodenectomy is feasible and allows timely and elective surgical control of carefully selected distal bile duct tumors in the setting of end-stage liver disease.
Varotti
Giovanni
G
Recanati/Miller Transplantation Institute, The Mount Sinai Hospital, New York, NY, USA.
Gondolesi
Gabriel E
GE
Roayaie
Sasan
S
Suriawinata
Arief
A
Soltys
Kyle
K
Fishbein
Thomas M
TM
Schwartz
Myron E
ME
Miller
Charles
C
D001650:Bile Duct Neoplasms / Q000150:complications / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic; D001706:Biopsy; D018281:Cholangiocarcinoma / Q000150:complications / Q000601:surgery*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D015209:Cholangitis, Sclerosing / Q000150:complications / Q000601:surgery*; D003131:Combined Modality Therapy; D005240:Feasibility Studies; D006498:Hepatectomy / Q000379:methods; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology; D017093:Liver Failure / Q000209:etiology; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016577:Pancreaticoduodenectomy / Q000379:methods*; D018579:Patient Selection; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome