title: Should possible recurrence of disease contraindicate liver transplantation in patients with end-stage alveolar echinococcosis? A 20-year follow-up study.
abstract: Liver transplantation (LT) is currently contraindicated in patients with residual or metastatic alveolar echinococcosis (AE) lesions. We evaluated the long-term course of such patients who underwent LT and were subsequently treated with benzimidazoles. Clinical, imaging, serological, and therapeutic data were collected from 5 patients with residual/recurrent AE lesions who survived for more than 15 years. Since 2004, [(18) F]-2-fluoro-2-deoxyglucose (FDG)-positron emission tomography (PET) images were available, and the levels of serum antibodies (Abs) against Echinococcus multilocularis-recombinant antigens were evaluated. Median survival time after LT was 21 years. These patients were from a prospective cohort of 23 patients with AE who underwent LT: 5 of 8 patients with residual/recurrent AE and 4 of 9 patients without residual/recurrent AE were alive in September 2009. High doses of immunosuppressive drugs, the late introduction of therapy with benzimidazoles, its withdrawal due to side effects, and nonadherence to this therapy adversely affected the prognosis. Anti-Em2(plus) and anti-rEm18 Ab levels and standard FDG-PET enabled the efficacy of therapy on the growth of EA lesions to be assessed. However, meaningful variations in Ab levels were observed below diagnostic cutoff values; and in monitoring AE lesions, images of FDG uptake taken 3 hours after its injection were more sensitive than images obtained 1 hour after its injection. In conclusion, benzimidazoles can control residual/recurrent AE lesions after LT. Using anti-rEm18 or anti-Em2(plus) Ab levels and the delayed acquisition of FDG-PET images can improve the functional assessment of disease activity. The potential recurrence of disease, especially in patients with residual or metastatic AE lesions, should not be regarded as a contraindication to LT when AE is considered to be lethal in the short term.
authors: World Health Organization Collaborating Centre for Prevention and Treatment of Human Echinococcosis, University Hospital and University of Franche-Comté, Besançon, France.
authors: Solange
authors: S
authors: Bresson-Hadni
authors: Oleg
authors: O
authors: Blagosklonov
authors: Jenny
authors: J
authors: Knapp
authors: Frédéric
authors: F
authors: Grenouillet
authors: Yasuhito
authors: Y
authors: Sako
authors: Eric
authors: E
authors: Delabrousse
authors: Marie-Pascale
authors: MP
authors: Brientini
authors: Carine
authors: C
authors: Richou
authors: Anne
authors: A
authors: Minello
authors: Anca-Teodora
authors: AT
authors: Antonino
authors: Michel
authors: M
authors: Gillet
authors: Akira
authors: A
authors: Ito
authors: Georges André
authors: GA
authors: Mantion
authors: Dominique Angèle
authors: DA
authors: Vuitton
mesh_terms: D000328:Adult; D001562:Benzimidazoles / Q000627:therapeutic use; D004443:Echinococcosis; D004444:Echinococcosis, Hepatic / Q000175:diagnosis* / Q000473:pathology; D058625:End Stage Liver Disease / Q000601:surgery / Q000628:therapy*; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000494:pharmacology; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography / Q000379:methods; D019275:Radiopharmaceuticals / Q000494:pharmacology; D012008:Recurrence; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome
chemical_list: D001562:Benzimidazoles; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18