De novo hepatocellular carcinoma in a non-cirrhotic allograft 27 years after liver transplantation: A case report

Am J Transplant. 2021 May;21(5):1953-1958. doi: 10.1111/ajt.16476. Epub 2021 Jan 23.


Hepatocellular carcinoma recurrence after liver transplantation is a well-known complication but the development of de novo hepatocellular carcinoma in non-cirrhotic allograft with no previous history of hepatic malignancy either in the donor or the recipient is extremely rare. A 33-year-old man underwent deceased donor liver transplantation due to HBV-HDV cirrhosis in 1991. The donor was healthy, with negative viral serology. Pretransplant assessment and explant liver pathology revealed no tumor. He developed an 8 cm mediastinal thymus cancer in 2014, a chronic myeloid leukemia in 2015 and a 16 mm renal cell carcinoma in 2017. After 27 years, in 2018, his routine follow-up sonography showed incidentally a 37 mm hepatic nodule in segment VII which revealed after percutaneous liver guided biopsy a hepatocellular carcinoma. As no extra hepatic metastasis was noted, segmentectomy was done. The pathological report confirmed a moderately differentiated hepatocellular carcinoma nodule of 50 mm diameter with absence of microvascular invasion and the non-tumoral liver showed histological features of NASH (SAF score: S1A2F3, NAS score: A3F3 and LAFSc:5) with absence of HBsAg and HBcAg. This case emphasizes the importance of long-term close surveillance by imaging of the graft even in the absence of viral recurrence and graft cirrhosis.

Keywords: cancer/malignancy/neoplasia; cancer/malignancy/neoplasia: registry/incidence; clinical research/practice; liver transplantation/hepatology; liver transplantation: auxiliary; liver transplantation: living donor; organ transplantation in general.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Allografts
  • Carcinoma, Hepatocellular* / etiology
  • Carcinoma, Hepatocellular* / surgery
  • Humans
  • Liver Cirrhosis / etiology
  • Liver Neoplasms* / etiology
  • Liver Neoplasms* / surgery
  • Liver Transplantation* / adverse effects
  • Living Donors
  • Male