Abstract
Not uncommonly, lung transplantation (LT) evaluation reveals a previously undiagnosed solid organ malignancy. We present the case of an LT candidate diagnosed with hepatocellular carcinoma (HCC), and the impact of treatment on candidacy and posttransplant course.
The patient is a 66-year-old man with a history of idiopathic pulmonary fibrosis and evidence of pulmonary hypertension who presented to our center for LT evaluation. In the pretransplant evaluation, abdominal imaging showed evidence for nodular liver contour, concerning for cirrhosis without features of portal hypertension. Follow-up MRI showed an enhancing, 1.1 × 1.7 × 2.1 cm lesion in hepatic segment 6 with washout appearance on delayed images, consistent with definitive HCC (Figure 1). At this time, tumor markers were negative. Given normal liver function as evidenced by normal platelet count and liver enzymes, concurrent microwave ablation and targeted biopsy was pursued, as well as non-targeted biopsy to determine the extent of liver fibrosis. Biopsies confirmed HCC and cirrhosis. He ultimately underwent transarterial chemoembolization without complication. After careful multidisciplinary review, he was subsequently listed for LT given ongoing respiratory deterioration. The patient underwent bilateral LT in May 2021, one month after the procedure. The immediate posttransplant course was complicated only by atrial fibrillation. Post-treatment MRI showed a 2.2 cm focus of diffusion restriction, considered to be treatment-related. At 1 month after transplant, he had evidence of portal hypertension (thrombocytopenia), but no esophageal varices on endoscopy. The patient is now 1.5 years from transplant with stable pulmonary function and compensated cirrhosis.
We present the case of a successful chemoembolization for HCC as a bridge to LT, with stable cirrhosis, post-treatment changes, and uncomplicated posttransplant course with preserved allograft function.