title: Long-term survival after liver transplant for recurrent hepatocellular carcinoma with bile duct tumor thrombus: case report.
abstract: OBJECTIVE
  Hepatocellular carcinoma with bile duct tumor thrombus is considered an aggressive malignancy, and the prognosis of liver transplant for it remains obscure.
  
  
  METHODS
  A 42-year-old man with recurrent hepatocellular carcinoma and a history of surgical resection was admitted to our hospital with a 10-day history of yellowish urine and itchy skin. There were 3 lesions in the right lobe with the diameter of 2 cm each. A mass was found in the upper part of common bile duct, and the intrahepatic bile duct was dilated. His serum alpha-fetoprotein level was 2476 μg/L, total bilirubin level was 327 μmol/L, direct bilirubin level was 261 μmol/L, and alanine aminotransferase was 714 U/L. There was no main portal vein thrombus or extrahepatic metastases. Because of his poor liver function, he was listed for a liver transplant. During the wait (30 d), he underwent 9 episodes of plasmapheresis to decrease the serum level of bilirubin. He had an orthotopic liver transplant with the graft from a deceased donor. After the liver transplant, he received 5 cycles of chemotherapy with the regimen of oxaliplatin and 5-fluorouracil.
  
  
  RESULTS
  This patient has survived without recurrence of hepatocellular carcinoma for more than 82 months and remains in good condition.
  
  
  CONCLUSIONS
  Liver transplant may have a favorable result for hepatocellular carcinoma patient with a bile duct tumor thrombus, within the Milan criteria.
authors: Department of Hepato-pancreato-biliary Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, Guangdong Province, China. mdliuchao@hotmail.com
authors: Chao
authors: C
authors: Liu
authors: Jie
authors: J
authors: Wang
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D001650:Bile Duct Neoplasms / Q000473:pathology*; D001653:Bile Ducts, Intrahepatic / Q000473:pathology*; D001663:Bilirubin / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D009364:Neoplasm Recurrence, Local; D009360:Neoplastic Cells, Circulating / Q000473:pathology; D011169:Portal Vein / Q000473:pathology; D013927:Thrombosis / Q000473:pathology*; D016896:Treatment Outcome; D000509:alpha-Fetoproteins / Q000032:analysis
chemical_list: D000509:alpha-Fetoproteins; D000410:Alanine Transaminase; D001663:Bilirubin