Orthotopic liver transplantation for giant liver haemangioma: A case report

作     者：Undine G Lange Julian N Bucher Markus B Schoenberg Christian Benzing Moritz Schmelzle Tanja Gradistanac Steffen Strocka Hans-Michael Hau Michael Bartels 

作者机构：Department of VisceralTransplantThoracic and Vascular SurgeryLeipzig University Hospital Department for GeneralVisceralTransplantationVascular and Thoracic SurgeryUniversity Hospital MunichLudwig-Maximilian-University Department of GeneralVisceral and Transplant SurgeryBerlin University Hospital Institute for PathologyLeipzig University Hospital Department of Diagnostic and Interventional RadiologyLeipzig University Hospital 

出 版 物：《World Journal of Transplantation》 (世界移植杂志)

年 卷 期：2015年第5卷第4期

页      面：354-359页

学科分类：10[医学] 

主　　题：Giant haemangioma Therapy refractory ascites Orthotopic liver transplantation Non-standard exception status Lab model for end-stage liver disease-based allocation system 

摘      要：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(lab MELD) 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 lab MELD-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 lab MELD score. Our case highlights the fact that liver transplantation should be considered early in patients with non-resectable, symptomatic benign liver tumours.