PRIMARY HEPATOCELLULAR-CARCINOMA AFTER ORTHOTOPIC LIVER-TRANSPLANTATION FOR CHRONIC HEPATITIS-B INFECTION

Nearly all patients having hepatic transplantation for chronic hepatitis B infection re-acquire this virus in their new liver. Chronic hepatitis B is a risk factor for developing hepatocellular carcinoma. Thus, liver transplant recipients with chronic hepatitis B may be at an increased risk for developing this tumor in their hepatic allograft. The patient described in this report had hepatic transplantation for progressive liver failure due to chronic hepatitis B infection. The donor had no serologic evidence of hepatitis B, and no evidence of hepatocellular carcinoma was present on pre-transplant evaluation or after careful examination of the explanted liver. Serologic and histologic evidence of hepatitis B infection developed within 4 to 6 months after transplantation. By 30 months, progressive liver dysfunction developed. A computed tomographic scan done at 47 months showed several intrahepatic masses, which at autopsy were found to represent multifocal hepatocellular carcinoma. This is the first documented case of primary hepatocellular carcinoma in the hepatic allograft of a patient with recurrent chronic hepatitis B infection. The carcinoma developed after only 4 years in this immunosuppressed patient, compared with more than 20 years for the average patient with chronic hepatitis B infection. We recommend that patients with chronic hepatitis B who need hepatic transplantation be counseled about the risk for hepatocellular carcinoma and screened for this tumor after transplantation.