Ann Hepatobiliary Pancreat Surg.  2020 May;24(2):188-191. 10.14701/ahbps.2020.24.2.188.

Living donor liver transplantation for unresectable colorectal liver metastasis: Report of a case with 13-year follow-up without recurrence

• Choi JU
• Hwang S
• Jung DH
• Park GC
• Ahn CS
• Kim KH
• Moon DB
• Ha TY
• Song GW
• Lee SG

• KMID: 2500804
• DOI: http://doi.org/10.14701/ahbps.2020.24.2.188

Abstract

The feasibility of liver transplantation (LT) for colorectal liver metastasis (CRLM) is still under investigation with only a limited number of LT cases in literature. CRLM is the most common type of liver metastasis, but it was considered as a contraindication to LT for a long time because of poor outcomes. We presented a case of living donor liver transplantation (LDLT) performed in a patient with liver cirrhosis and CRLM. The patient was a 49-year-old female with sigmoid colon cancer and synchronous multiple CRLM. She underwent anterior resection for sigmoid colon cancer and 7 sessions of chemotherapy for CRLM. She suffered from esophageal varix bleeding due to chemotherapy-associated liver cirrhosis. Because of liver cirrhosis and multiple CRLM, the patient underwent LDLT operation using a modified right lobe graft. Serum chorioembryonic antigen level was 220 ng/mL at LT. Explant liver pathology showed multiple metastatic adenocarcinomas of colonic origin, up to 4.7 cm in the greatest dimension. The patient did not receive any specific anti-tumor treatment after LT. She is doing well without any tumor recurrence to date for more than 13 years after the LDLT operation. The experience on our case and literature review suggest that CRLM is not always contraindicated for LT because some selected patients showed improved long-term survival outcomes.

Keyword

Colorectal cancer; Colorectal cancer; Living donor liver transplantation; Adenocarcinoma

Figure

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  Fig. 1 Pretransplant computed tomography (CT) findings. (A) A CT image taken at the time of colon cancer surgery (October 2004) showed multiple liver metastasis from sigmoid colon cancer. (B) A CT image taken at liver transplantation (January 2007) showed multiple unresectable colorectal liver metastasis.

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  Fig. 2 Intraoperative photograph of the liver graft implantation. There was a small area of hepatic venous congestion after reperfusion with portal blood flow.

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  Fig. 3 Gross photograph of the explant liver. There were multiple metastatic adenocarcinomas of colonic origin combined with liver cirrhosis.

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  Fig. 4 Posttransplant computed tomography (CT) findings. (A) A CT image taken at 2 weeks after liver transplantation showed no abnormal finding. (B) A CT image taken at 12 years after liver transplantation showed no evidence of tumor recurrence.

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