Liver Transplantation for a Patient with Hepatic Echinococcosis

 

Indications for liver transplantation for a patient with hepatic echinococcosis:

(1) one or more of the following:

(1a) chronic liver failure (Budd-Chiari syndrome, secondary biliary cirrhosis, etc)

(1b) recurrent life-threatening cholangitis

(2) inability to perform a radical hepatic resection (extensive and inoperable lesions)

 

Relative contraindication:

(1) inoperable extra-hepatic alveolar echinococcosis (immunosuppression for the liver transplant may be associated with larval growth)

 

For patients with extra-hepatic disease PET scan (with scanning 3 hours after injection) can identify extra-hepatic lesions and benzimidazole therapy may be able to control them but must be taken lifelong (Bresson-Hadni et al, 2011). Poor adherence to benzimidazole therapy or its discontinuation for adverse effects can result in disease progression.