Liver Transplantation in a Monolung Patient: A Strategy of Sequential Treatments of Multiple Lung Tuberculosis Ca-vitations and Hepatocellular Carcinoma on Hepatitis B Related Virus Cirrhosis ()
ABSTRACT
The presence of extrahepatic infection is a contraindication for liver transplantation, even more if supported by an advanced pulmonary tuberculosis with persistent cavitation not curable with medical treatment. We report a case of a young patient with hepatocellular carcinoma on hepatitis B virus related liver cirrhosis and multiple lung tuberculosis cavitations. The patient was referred to our centre for liver transplantation. We adopted a strategy with sequential treatments. First a left extra-pericardial pneumonectomy was performed without opening the infected cavern, followed by a therapy with rifampicin, isoniazid and ethambutol for a period of nine months. After the cure of tuberculosis, the monolung patient eventually was listed for liver transplantation. An accurate planning of a multistep therapeutical strategy, an appropriate anesthetic management and a meticulous surgical technique allowed to successfully transplant a young patient suffering from three life-threatening diseases: cavitary tuberculosis, hepatitis B virus cirrhosis and hepatocellular carcinoma. Thirty months after liver transplantation the patient is in good health, with normal liver function, forced expiratory volume in one second of 42% (1.53 liters) and without any tuberculosis disease reactivation.
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D. Donataccio, P. Bravo, A. Masotto, M. Ceola, F. Calabrò and M. Donataccio, "Liver Transplantation in a Monolung Patient: A Strategy of Sequential Treatments of Multiple Lung Tuberculosis Ca-vitations and Hepatocellular Carcinoma on Hepatitis B Related Virus Cirrhosis,"
Surgical Science, Vol. 2 No. 5, 2011, pp. 257-261. doi:
10.4236/ss.2011.25057.