Introduction: Liver transplantation for patients with early unresectable intrahepatic hepatocellular carcinoma is the best option. Salvage liver transplantation is another option for patients with recurrence after hepatectomy. However, It is acknowledged as relative contraindication for patients with single lymph node metastasis after hepatectomy.
We present a patient who was with single lymph node metastasis after hepatectomy and underwent ABOi and live donor liver transplantation
Material and Methods: The patient was fifty years old male with HBV related liver cirrhosis, hepatocellular carcinoma, and moderate amount of ascites. The patient underwent segment 5 wedge resection, however liver function was aggravated with ascites. He suffered severe ascites for several months after hepatectomy. Therefore, the patient was referred to transplantation center and was included to waiting list for DDLT. However, the CT scan shows single portocaval lymph node enlargement and interval increase, even though there was no recurrence in the liver. There was no other metastasis in the image evalution. Preoperative serum AFP level was 2.1 ng/ml. We explained the status and the risk of recurrence after liver transplantation to the patient and family. His son asked us to perform live donor liver transplantation. We prepared ABOi LDLT because of the incompatible blood type between donor and recipient. Unusually, recipient operation was performed before donor hepatectomy to rule out peritoneal seeding or other metastasis. After recipient hepatectomy, single portocaval LN was dissected. There were no other suspicious LN enlargement.
Results: The operation time was 880 min and estimated blood loss was 5000 ml. The warm ischemic time was 38 min and cold ischemic time was 190 min. There was no severe complication after LT. The patient was discharged 24 days after operation. The follow up duration after LT is 20 months. The patient takes everolimus in addition to tacrolimus for the purpose of preventing tumor recurrence. CT scan shows no recurrence and Serum AFP level was 1.6 ng/ml 20 months after liver transplantation.
Conclusions: Lymph node metastasis after hepatectomy is usual contraindication for DDLT. However, selective live donor LT with resection of single lesion could be performed for patients with stable HCC and single lesion metastasis. We should check the possible recurrence closely for years because the follow up duration is not enough.