Anesthetic Management for Resection of Hepatic Paraganglioma Metastatic From the Donor Organ in an Orthotopic Liver Transplant Recipient: A Case Report

Abstract

This is a case report of the anesthetic management for the hepatic resection of a metastatic paraganglioma in a patient with a history of prior orthotopic liver transplantation. Of interest, the metastatic paraganglioma originated from the donor organ. The patient is an 80-year-old woman with multiple medical problems including a history of cryptogenic cirrhosis who underwent successful orthotopic liver transplantation 9 years prior. She later presented with signs and symptoms of catecholamine excess suggestive of a catecholamine-producing tumor (paraganglioma or pheochromocytoma). Elevated urine catecholamine levels and radiographic evidence of a paraganglioma in the transplanted liver metastatic from the donor organ confirmed the diagnosis. Radiofrequency ablation of the tumor and surgical resection was previously attempted without success. We describe the anesthetic management for the successful resection of the metastatic hepatic paraganglioma, which was complicated by profound intraoperative hypertension and hypotension that necessitated the use of multiple vasoactive infusions, extensive surgical blood loss requiring blood transfusion, and difficult glycemic control in an insulin-dependent diabetic patient. The postoperative course is also described. This unique case presented the anesthesia team with challenges specific to both surgery for hepatic resection as well as for catecholamine-secreting tumors. We are not aware of any reports of paragangliomas of either donor or recipient origin involving a transplanted liver, making this the first such report to the best of our knowledge.

RE: Anesthetic Management for Resection of Hepatic Paraganglioma Metastatic From the Donor Organ in an Orthotopic Liver Transplant Recipient: A Case Report

“…A S stated in the case report [1], this is the first published case of donor transmitted paraganglioma. Additional details of the case relevant to the behavior of the paraganglioma are briefly summarized below.…”

“…A biopsy was performed and histologic examination revealed a paraganglioma. Subsequent radiofrequency ablations (RFA) and surgical management are detailed in the case report [1]. Postoperative CT scan showed a residual lesion in the left hepatic lobe which was resected approximately one year later.…”

Primary Functioning Hepatic Paraganglioma Treated by Laparoscopy: A Case Report

“…To date, a total of 13 cases of hepatic paraganglioma have been reported by a thorough search of the PubMed database between 1995 and 2022 [15][16][17][18][19][20][21][22][23][24][25][26][27]. A retrospective chart review and summary of clinical features are presented in Table 2.…”