Indication for liver transplantation in a patient with a history of a gastric lymphoma

Abstract

The indication for liver transplantation in patients with history of lymphoma is little-known, and the references documented in the medical literature are still limited. We present the case of a 63-year-old man who was diagnosed with chronic hepatopathy due to HBV 15 years ago. He was operated on for hepatocellular carcinoma in the segment VI of the liver 4 years ago, finding a macronodular liver cirrhosis during the surgery. Fifteen months later, the patient was diagnosed with diffuse large B-cell gastric lymphoma (fig.1). After a good response to chemotherapy treatment with R-CHOP scheme, the patient has been in complete remission for 36 months. Currently, the patient has a Child-Pugh score of 5 points, MELD score of 6 points, an undetectable viral load and it does not exist any evidence of hepatocellular carcinoma recurrence. With respect to this case, could it be considered liver transplantation in any assumption or would it be rejected in any case due to the recent history of lymphoma? In this case report, it has decided to do a periodic follow-up of the patient, but because of the good prognosis of the lymphoma, liver transplantation may be performed in the case of hepatocellular recurrence, worsening of liver function (Child-Pugh B or C) or fulminant hepatic failure due to HBV reactivation. There is not yet consensus about the interval between lymphoma remission and liver transplantation, therefore it recommends an individual oncologic evaluation in order to establish the recurrence risk before deciding on the indication for liver transplantation.