Intrahepatic De Novo Tumors in Liver Recipients are Highly Associated With Recurrent Viral Hepatitis

Michael J Pflüger; Max M Maurer; Karl H Hillebrandt; Andreas Andreou; Dominik Geisel; Moritz Schmelzle; Johann Pratschke; Dennis Eurich

doi:10.1016/j.jceh.2020.11.003

Intrahepatic De Novo Tumors in Liver Recipients are Highly Associated With Recurrent Viral Hepatitis

J Clin Exp Hepatol. 2021 Jul-Aug;11(4):435-442. doi: 10.1016/j.jceh.2020.11.003. Epub 2020 Nov 25.

Authors

Michael J Pflüger^{1

2}, Max M Maurer¹, Karl H Hillebrandt¹, Andreas Andreou^{1

3}, Dominik Geisel⁴, Moritz Schmelzle¹, Johann Pratschke¹, Dennis Eurich¹

Affiliations

¹ Department of Surgery, Campus Charité Mitte | Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany.
² Department of Pathology, Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
³ Liver and Kidney Transplant Center, Inselspital - Bern University Hospital, Switzerland.
⁴ Department of Radiology (including Pediatric Radiology), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany.

Abstract

Background/aims: Long-term survival of liver transplant recipients is endangered by tumorigenesis at different sites. Little is known about primary de novo tumors developing in the graft.

Methods: We analyzed the follow-up data of 2731 liver recipients that were transplanted between 1988 and 2019 at our institution (Charité - Universitätsmedizin Berlin, Department of Surgery). All cases with new intrahepatic tumors during follow-up were identified.

Results: A total of nine patients were diagnosed at a median of 16 years (range, 2-24 years) after surgery. Eight patients presented with hepatocellular carcinoma (HCC), and one patient presented with epithelioid hemangioendothelioma (EHE). All eight HCC patients had a recurrence of the initial disease that had caused liver failure before transplantation. This was associated with viral reinfection with either HCV or HBV in seven cases. Of the nine patients, three underwent surgical resection and only one patient was alive at data abstraction.

Conclusion: Intrahepatic de novo neoplasms in the liver graft need to be considered in the long-term follow-up of liver recipients and were strongly associated with recurrent viral hepatitis in our study. Although prognosis of this rare complication is generally poor, patients may benefit from surgical resection of localized disease.

Keywords: AFP, alpha-fetoprotein; ALF, acute liver failure; CA 19-9, carbohydrate antigen 19-9; CCA, cholangiocarcinoma; CEA, carcinoembryonic antigen; DCV, daclatasvir; EHE, epithelioid hemangioendothelioma; ESLD, end-stage liver disease; HBIG, hepatitis B immune globulin; HBsAg, hepatitis B surface antigen; HCC, hepatocellular carcinoma; IS, immunosuppressive therapy; LT, liver transplantation; NUCs, nucleos(t)ide analogues; PSC, primary sclerosing cholangitis; PTLD, post-transplantation lymphoproliferative disorder; PegIFN, pegylated interferon; RBV, ribavirin; SOF, sofosbuvir; SVR, sustained viral response; epithelioid hemangioendothelioma; hepatocellular carcinoma; liver transplant; long-term survival; surgical resection.