Published online Dec 28, 2017. doi: 10.4254/wjh.v9.i36.1361
Peer-review started: August 25, 2017
First decision: November 1, 2017
Revised: November 22, 2017
Accepted: December 7, 2017
Article in press: December 8, 2017
Published online: December 28, 2017
Processing time: 124 Days and 8.4 Hours
De-novo malignancies carry an incidence ranging between 3%-26% after transplant and account for the second highest cause of post-transplant mortality behind cardiovascular disease. While the majority of de-novo malignancies after transplant usually consist of skin cancers, there has been an increasing rate of solid tumor cancers over the last 15 years. Although, recurrence of hepatocellular carcinoma (HCC) is well understood among patients transplanted for HCC, there are increasing reports of de-novo HCC in those transplanted for a non-HCC indication. The proposed pathophysiology for these cases has been mainly connected to the presence of advanced graft fibrosis or cirrhosis and always associated with the presence of hepatitis B or C virus. We report the first known case of de-novo HCC in a recipient, 14 years after a pediatric living related donor liver transplantation for end-stage liver disease due to biliary atresia without the presence of hepatitis B or C virus before and after transplant. We present this case report to increase the awareness of this phenomenon and address on the utility for screening and surveillance of hepatocellular carcinoma among these individuals. One recommendation is to use similar guidelines for screening, diagnosis, and treatment for HCC as those used for primary HCC in the pre-transplant patient, focusing on those recipients who have advanced fibrosis in the allograft, regardless of etiology.
Core tip:De-novo hepatocellular carcinoma (HCC) is a rare event compared to other de-novo malignancies, although the number of reported cases are increasing. The pathophysiology has been related with advanced graft fibrosis, cirrhosis and hepatitis viral serology. We report the first case of De-novo HCC 14 years after living related donor liver transplantation for end-stage liver disease due to biliary atresia without positive hepatitis B or C viral serology. Current screening and treatment guidelines have not been well established. This increasing phenomenon challenges us to define the utility of screening and surveillance for hepatocellular carcinoma in these individuals.