Successful outcome after transplantation of a donor liver with focal nodular hyperplasia

Abstract

Because of the increasing gap in the number of patients awaiting organ transplantation and the supply of organ donors, reevaluation of donor criteria is an important issue in clinical transplantation. It has become necessary to make maximal use of the currently available donor pool. We describe a case of successful orthotopic liver transplantation in a 57-year-old man with Laënnec's cirrhosis using a liver containing an 8-cm focal nodular hyperplasia (FNH) lesion involving segments II and III and the caudate lobe. The donor liver was procured from a 46-year-old woman declared brain dead after a subarachnoid hemorrhage. Definitive pathological diagnosis was made at laparotomy by obtaining a Tru-cut (Allegiance Health Care Inc, Toronto, Ontario, Canada) core biopsy specimen. The recipient operation was performed uneventfully except for bleeding from the biopsy site. The patient did well postoperatively and was discharged on tacrolimus, mofetil mycophenolate, and prednisone therapy. He continues to thrive 2 1 ⁄2 years posttransplantation with no change in the size of the lesion. In well-selected donors, FNH should not be a contraindication for use in transplantation. However, FNH must be differentiated from hepatocellular adenoma. Although FNH has a benign course with little propensity for bleeding and almost no malignant potential, hepatic adenoma is reported to have a 15% to 33% chance of bleeding and rupture with a well-documented potential for neoplastic degeneration, making the liver unsuitable for donation. O rgan transplantation is widely accepted as therapy for end-stage organ disease of the liver, kidney, pancreas, heart, and lung. Although many advances have been made in surgical technique and immunosuppression, significant disparity remains between the number of donor organs available and the multitude of potential recipients on waiting lists. The gap between donor availability and recipient need has grown over the last decade. 1,2 Consequently, criteria for use of organs are constantly being reassessed. Mass lesions in the liver should not be an absolute contraindication for use as a donor organ.We present a case in which a donor liver with focal nodular hyperplasia (FNH) was successfully transplanted into a recipient with end-stage alcoholic liver disease. This case emphasizes the need for maximal use of the available donor pool and shows that good postoperative outcome can be achieved despite using what would grossly appear to be a less-than-ideal organ. Case ReportA 57-year-old man presented with a 30-pound weight loss, fatigue, jaundice, and increasing abdominal girth over 6 months. He had a 40-year history of alcohol consumption. The patient admitted drinking at least 350 mL of beer daily. On physical examination, the patient was jaundiced, with spider angiomas, palmar erythema, and ascites. He was alert and oriented with no evidence of hepatic encephalopathy. His past medical history was unremarkable except for a lower gastrointestinal bleed (of unknown severity) approximately 1 year before presen...