title: Orthotopic liver transplantation for giant liver haemangioma: A case report.
abstract: In liver haemangiomas, the risk of complication rises with increasing size, and treatment can be obligatory. Here we present a case of a 46-year-old female who suffered from a giant haemangioma causing severe portal hypertension and vena cava compression, leading to therapy refractory ascites, hyponatremia and venostasis-associated thrombosis with pulmonary embolism. The patients did not experience tumour rupture or consumptive coagulopathy. Surgical resection was impossible because of steatosis of the non-affected liver. Orthotopic liver transplantation was identified as the only treatment option. The patient's renal function remained stable even though progressive morbidity and organ allocation were improbable according to the patient's lab model for end-stage liver disease (labMELD) score. Therefore, non-standard exception status was approved by the European organ allocation network "Eurotransplant". The patient underwent successful orthotopic liver transplantation 16 mo after admission to our centre. Our case report indicates the underrepresentation of morbidity associated with refractory ascites in the labMELD-based transplant allocation system, and it indicates the necessity of promptly applying for non-standard exception status to enable transplantation in patients with a severe clinical condition but low labMELD score. Our case highlights the fact that liver transplantation should be considered early in patients with non-resectable, symptomatic benign liver tumours.
authors.affiliation: Undine G Lange, Christian Benzing, Hans-Michael Hau, Michael Bartels, Department of Visceral, Transplant, Thoracic and Vascular Surgery, Leipzig University Hospital, 04103 Leipzig, Germany.
authors.forename: Undine G
authors.initials: UG
authors.lastname: Lange
authors.affiliation: Undine G Lange, Christian Benzing, Hans-Michael Hau, Michael Bartels, Department of Visceral, Transplant, Thoracic and Vascular Surgery, Leipzig University Hospital, 04103 Leipzig, Germany.
authors.forename: Julian N
authors.initials: JN
authors.lastname: Bucher
authors.affiliation: Undine G Lange, Christian Benzing, Hans-Michael Hau, Michael Bartels, Department of Visceral, Transplant, Thoracic and Vascular Surgery, Leipzig University Hospital, 04103 Leipzig, Germany.
authors.forename: Markus B
authors.initials: MB
authors.lastname: Schoenberg
authors.affiliation: Undine G Lange, Christian Benzing, Hans-Michael Hau, Michael Bartels, Department of Visceral, Transplant, Thoracic and Vascular Surgery, Leipzig University Hospital, 04103 Leipzig, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Benzing
authors.affiliation: Undine G Lange, Christian Benzing, Hans-Michael Hau, Michael Bartels, Department of Visceral, Transplant, Thoracic and Vascular Surgery, Leipzig University Hospital, 04103 Leipzig, Germany.
authors.forename: Moritz
authors.initials: M
authors.lastname: Schmelzle
authors.affiliation: Undine G Lange, Christian Benzing, Hans-Michael Hau, Michael Bartels, Department of Visceral, Transplant, Thoracic and Vascular Surgery, Leipzig University Hospital, 04103 Leipzig, Germany.
authors.forename: Tanja
authors.initials: T
authors.lastname: Gradistanac
authors.affiliation: Undine G Lange, Christian Benzing, Hans-Michael Hau, Michael Bartels, Department of Visceral, Transplant, Thoracic and Vascular Surgery, Leipzig University Hospital, 04103 Leipzig, Germany.
authors.forename: Steffen
authors.initials: S
authors.lastname: Strocka
authors.affiliation: Undine G Lange, Christian Benzing, Hans-Michael Hau, Michael Bartels, Department of Visceral, Transplant, Thoracic and Vascular Surgery, Leipzig University Hospital, 04103 Leipzig, Germany.
authors.forename: Hans-Michael
authors.initials: HM
authors.lastname: Hau
authors.affiliation: Undine G Lange, Christian Benzing, Hans-Michael Hau, Michael Bartels, Department of Visceral, Transplant, Thoracic and Vascular Surgery, Leipzig University Hospital, 04103 Leipzig, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Bartels
keywords: Giant haemangioma; Lab model for end-stage liver disease -based allocation system; Non-standard exception status; Orthotopic liver transplantation; Therapy refractory ascites