title: Rescue Living-donor Liver Transplantation for Liver Failure Following Hepatectomy for Hepatocellular Carcinoma.
abstract: Liver failure following major hepatectomy for hepatocellular carcinoma is a known but uncommon mode of early treatment failure. When post-hepatectomy liver failure becomes progressive, the only effective treatment for rescuing the patient is liver transplantation. Deceased-donor liver transplantation in this situation is often not feasible because of the shortage of deceased-donor liver grafts. Proceeding with living-donor liver transplantation is an ethical challenge because of the possibility of donor coercion. In addition, tumor status, as confirmed by histopathological examination of the resected specimen, may indicate aggressive cancer that warns against rescue transplantation because of the increased chance of tumor recurrence. Here we describe four cases of rescue living-donor liver transplantation for liver failure after hepatectomy for hepatocellular carcinoma. The patients all survived the transplantation and were free from tumor recurrence after follow-up periods ranging from 6 months to 9 years. Our experience has shown that rescue living-donor liver transplantation for post-hepatectomy liver failure is feasible. Tumor status should be considered carefully because large tumors and tumors with macrovascular invasion are strong contraindications to rescue living-donor liver transplantation.
authors.affiliation: Department of Surgery, The University of Hong Kong, Hong Kong, SAR, China ; State Key Laboratory for Liver Research, The University of Hong Kong, Hong Kong, SAR, China.
authors.forename: See Ching
authors.initials: SC
authors.lastname: Chan
authors.affiliation: Department of Surgery, The University of Hong Kong, Hong Kong, SAR, China.
authors.forename: William Wei
authors.initials: WW
authors.lastname: Sharr
authors.affiliation: Department of Surgery, The University of Hong Kong, Hong Kong, SAR, China.
authors.forename: Albert Chi Yan
authors.initials: AC
authors.lastname: Chan
authors.affiliation: Department of Surgery, The University of Hong Kong, Hong Kong, SAR, China.
authors.forename: Kenneth Siu Ho
authors.initials: KS
authors.lastname: Chok
authors.affiliation: Department of Surgery, The University of Hong Kong, Hong Kong, SAR, China ; State Key Laboratory for Liver Research, The University of Hong Kong, Hong Kong, SAR, China.
authors.forename: Chung Mau
authors.initials: CM
authors.lastname: Lo
keywords: Hepatocellular carcinoma; Liver failure; Living-donor liver transplantation; Rescue