Eurotransplant special request for high-urgency status after liver transplantation for hepatocellular carcinoma: a case report.
Hepatic artery thrombosis after liver transplantation remains a major indication for retransplantation. We report the case of a 49-year-old man with a hepatocellular carcinoma in the setting of cirrhosis associated with chronic hepatitis B and C infections who underwent split liver transplantation. The patient experienced a complicated postoperative course, characterized by 2 relaparotomies for necrosis of segment IV, and a late hepatic artery thrombosis, first discovered on postoperative day 20. His subsequent course was characterized by relapsing cholangitis and liver abscesses requiring antibiotics and percutaneous drainage. Transient control of the septic complications allowed for the filing of a special high-urgency status request that was approved by Eurotransplant. The patient underwent retransplantation 1 week later with a full-size deceased donor graft. He is currently alive, well, with no evidence of tumor recurrence at 30 months posttransplantation. The existence of exceptions within the system, such as the "special high-urgency status" of Eurotransplant, as well as the aggressive treatment of complications to obtain a "window of clinical opportunity" saved this patient's life.
Sotiropoulos
G C
GC
Department of General, Visceral, and Transplantation Surgery, University Hospital Essen, Essen, Germany; Department of General and Abdominal Surgery, Johannes Gutenberg University Hospital, Mainz, Germany. sotiropoulos@ach.klinik.uni-mainz.de
Treckmann
J
J
Fouzas
I
I
Molmenti
E P
EP
Nowak
K M
KM
Broelsch
C E
CE
Paul
A
A
Lang
H
H
D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery / Q000821:virology; D004630:Emergencies; D006499:Hepatic Artery / Q000473:pathology*; D006509:Hepatitis B / Q000150:complications; D006526:Hepatitis C / Q000150:complications; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery / Q000821:virology; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D013927:Thrombosis / Q000209:etiology*; D016896:Treatment Outcome