Rabia Rizwan, MD1, Apaar Dadlani, MD2, Hamza Khan, MD3, Tamneet Basra, MD1, David Victor, MD1, Michelle Jones-Pauley, MD2, Mary R. Schwartz, MD2, Sadhna Dhingra, MD2, Sudha Kodali, MD2 1Houston Medical Center, Houston, TX; 2Houston Methodist Hospital, Houston, TX; 3Houston Methodist, Houston, TX Introduction: De-novo hepatocellular carcinoma (HCC) following liver transplantation is extremely rare, typically occurring in the context of viral hepatitis, cirrhosis or recurrence of underlying liver disease. We present the first known case of de-novo HCC occurring 30 years after pediatric living donor liver transplant (LDLT) for biliary atresia, in the absence of hepatitis B or C and without established cirrhosis.
Case Description/
Methods: A 30-year-old female with a history of LDLT from her biological mother at 3 months of age for biliary atresia following failed Kasai procedure, presented with nausea, vomiting, unintentional weight loss and abdominal pain for a few weeks. Her post-transplant course was complicated by early multiple vascular thromboses requiring shunting procedures, splenectomy, chronic rejection and autoimmune hepatitis. She was being monitored with routine lab tests every 6 months that had been normal previously. At the time of this presentation, Lab results showed elevated alpha-fetoprotein of 105 ng/mL and total bilirubin of 3.9 mg/dL, and features of cholestatic hepatitis. MRI demonstrated a new 4.3 cm arterially enhancing mass in hepatic segment VIII concerning for Adenoma vs HCC. Given her long term use of Immunosuppression and elevated AFP, though she lacked any other risk factors, a biopsy of the mass was performed that showed HCC; biopsied of non-mass allograft showed features of biliary obstruction, neutrophilic abscesses and stage 2-3 fibrosis. After completing antibiotics which were initiated for the abscesses noted on biopsy, her bilirubin normalized. Surgical resection was not feasible due to complex vascular anatomy. The patient is planned to undergo Y-90 radioembolization and was evaluated and approved for repeat liver transplantation. Discussion: While HCC recurrence occurs in up to 18.3% of liver transplant recipients, de-novo HCC is exceedingly rare with only a few cases reported in the literature. It is usually associated with viral hepatitis or cirrhosis of the allograft. This case represents the longest reported interval between LDLT and the development of de-novo HCC (30 years) that we are aware of. It underscores the need for high clinical suspicion when patients present with sudden onset of constitutional symptoms and abnormal imaging, even in the absence of traditional risk factors.
Figure: MRI demonstrating hepatic mass during arterial enhancement with T1-weighted fat-saturated images
Figure: Liver biopsy of the mass showing de-novo moderately differentiated hepatocellular carcinoma with clear cell change
Disclosures: Rabia Rizwan indicated no relevant financial relationships. Apaar Dadlani indicated no relevant financial relationships. Hamza Khan indicated no relevant financial relationships. Tamneet Basra indicated no relevant financial relationships. David Victor indicated no relevant financial relationships. Michelle Jones-Pauley indicated no relevant financial relationships. Mary Schwartz indicated no relevant financial relationships. Sadhna Dhingra indicated no relevant financial relationships. Sudha Kodali: ASTRAZENECA – Advisory Committee/Board Member. GILEAD – Advisor or Review Panel Member, Advisory Committee/Board Member, Speakers Bureau. SIRTEX – Advisor or Review Panel Member.
Rabia Rizwan, MD1, Apaar Dadlani, MD2, Hamza Khan, MD3, Tamneet Basra, MD1, David Victor, MD1, Michelle Jones-Pauley, MD2, Mary R. Schwartz, MD2, Sadhna Dhingra, MD2, Sudha Kodali, MD2. P6143 - <i>De Novo</i> Hepatocellular Carcinoma 30 Years Post-Living Donor Liver Transplant in a Patient With Biliary Atresia, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
