First Attempt of Sequential Living Donor Liver and Hematopoietic Stem Cell Transplantation in a Child With Advanced Hepatocellular Carcinoma

Case Report

J. A. Picoraro, Nadia Ovchinsky, M. Martinez, S. J. Lobritto, P. Satwani, R. Ramphal, M. S. Cairo, T. Kato

Research output: Contribution to journalArticle

Abstract

Effective therapeutic options for advanced hepatocellular carcinoma are limited. Hematopoietic stem cell transplantation may offer a graft-versus-tumor effect. Combined liver and hematopoietic stem cell transplantation from the same donor with preparatory conditioning may promote tolerogenicity to the liver allograft and offers the potential for immunosuppression withdrawal. We report our experience with the use of this approach in a pediatric patient with invasive hepatocellular carcinoma and pulmonary metastases who underwent a living-donor liver transplantation followed by reduced-toxicity myeloablative conditioning and hematopoietic stem cell transplant from the same parental donor. Neutrophil engraftment and full donor chimerism was achieved without liver allograft dysfunction. Despite normal liver function and marrow engraftment, the patient succumbed to multisystem organ failure from disseminated toxoplasmosis. At autopsy, there was no histologic evidence of tumor recurrence. No pulmonary nodules were found. Regardless of the unfortunate overall result, this case demonstrates preliminary feasibility of sequential living-donor liver transplantation and hematopoietic stem cell transplantation for unresectable and metastasized hepatic tumors. Future studies in select pediatric patients require evaluation of the optimal conditioning regimen and prevention strategies for opportunistic infections to determine both graft-versus-tumor effect on hepatic tumors and durability of tolerogenicity and possible immunosuppression withdrawal.

Original languageEnglish (US)
Pages (from-to)3174-3177
Number of pages4
JournalTransplantation Proceedings
Volume48
Issue number9
DOIs
StatePublished - Nov 1 2016

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Living Donors
Hematopoietic Stem Cell Transplantation
Hepatocellular Carcinoma
Liver
Tissue Donors
Neoplasms
Transplants
Liver Transplantation
Immunosuppression
Allografts
Pediatrics
Lung
Chimerism
Toxoplasmosis
Opportunistic Infections
Hematopoietic Stem Cells
Liver Diseases
Autopsy
Neutrophils
Bone Marrow

ASJC Scopus subject areas

  • Surgery
  • Transplantation

Cite this

First Attempt of Sequential Living Donor Liver and Hematopoietic Stem Cell Transplantation in a Child With Advanced Hepatocellular Carcinoma : Case Report. / Picoraro, J. A.; Ovchinsky, Nadia; Martinez, M.; Lobritto, S. J.; Satwani, P.; Ramphal, R.; Cairo, M. S.; Kato, T.

In: Transplantation Proceedings, Vol. 48, No. 9, 01.11.2016, p. 3174-3177.

Research output: Contribution to journalArticle

Picoraro, J. A. ; Ovchinsky, Nadia ; Martinez, M. ; Lobritto, S. J. ; Satwani, P. ; Ramphal, R. ; Cairo, M. S. ; Kato, T. / First Attempt of Sequential Living Donor Liver and Hematopoietic Stem Cell Transplantation in a Child With Advanced Hepatocellular Carcinoma : Case Report. In: Transplantation Proceedings. 2016 ; Vol. 48, No. 9. pp. 3174-3177.
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