Clinical case of liver transplantation in a kidney transplant recipient with hepatocellular cancer and сoronary artery disease

Objective: organ transplantation is a highly effective and often the only possible definitive treatment for terminal diseases, significantly improving patient survival and quality of life. However, recipients have a higher risk of developing cardiovascular and oncological diseases, and are susceptible to decompensation of pre-existing diseases. Prevention and treatment of these conditions are becoming critical tasks in transplantology, requiring multidisciplinary collaboration. Materials and methods. This article presents a clinical case of the treatment of a patient with stage 5 chronic kidney disease, concomitant cardiologic pathologies and subsequently diagnosed hepatocellular cancer on the background of hepatitis C-related liver cirrhosis. Competent interaction and bridge therapy yielded successful consecutive kidney and liver transplantation with satisfactory outcomes. Conclusion. Our treatment experience has shown the effectiveness and necessity of a multidisciplinary approach, early diagnosis, therapy modification during transplantation and further treatment of patients with end-stage multiple organ dysfunction.

1. Abecassis M, Bartlett ST, Collins AJ, Davis CL, Delmonico FL, Friedewald JJ et al. Kidney transplantation as primary therapy for end-stage renal disease: a National Kidney Foundation/Kidney Disease Outcomes Quality Initiative (NKF/KDOQI™) conference. Clin J Am Soc Nephrol. 2008; 3 (2): 471–480. doi: 10.2215/CJN.05021107.

2. United States Renal Data System. 2021 USRDS annual data report: epidemiology of kidney disease in the United States. https://www.usrds.org/adr.aspx.2021.

3. Andrusev AM, Tomilina NA, Peregudova NG, Shinkarev MB. Kidney replacement therapy for end Stage Kidney Disease in Russian Federation, 2015–2019. Russian National Kidney Replacement Therapy Registry Report of Russian Public Organization of Nephrologists «Russian Dialysis Society». Nephrology and Dialysis. 2021; 23 (3): 255–329. [In Russ, English abstract]. doi: 10.28996/2618-9801-2021-3-255-329.

4. Müller PC, Kabacam G, Vibert E, Germani G, Petrowsky H. Current status of liver transplantation in Europe. Int J Surg. 2020; 82S: 22–29. PMID: 32454252. doi: 10.1016/j.ijsu.2020.05.062.

5. Hughes CB, Humar A. Liver transplantation: current and future. Abdom Radiol (NY). 2021; 46 (1): 2–8.

6. Kasiske BL, Zeier MG, Chapman JR, Craig JC, Ekberg H, Garvey CA et al. KDIGO clinical practice guideline for the care of kidney transplant recipients: a summary. Kidney Int. 2010; 77 (4): 299–311. PMID: 19847156. doi: 10.1038/ki.2009.377.

7. Yu M, Liu M, Zhang W, Ming Y. Pharmacokinetics, pharmacodynamics and pharmacogenetics of tacrolimus in kidney transplantation. Curr Drug Metab. 2018; 19 (6): 513–522. doi: 1389200219666180129151948.

8. Parlakpinar H, Gunata M. Transplantation and immunosuppression: a review of novel transplantrelated immunosuppressant drugs. Immunopharmacol Immunotoxicol. 2021; 43 (6): 651–665. doi: 10.1080/08923973.2021.1966033.

9. Mazzaferro V, Bhoori S, Sposito C, Bongini M, Langer M, Miceli R, Mariani L. Milan criteria in liver transplantation for hepatocellular carcinoma: an evidencebased analysis of 15 years of experience. Liver Transpl. 2011; 17 (S2): S44–S57. doi: 10.1002/lt.22365.

10. Cucchetti A, Serenari M, Sposito C, Di Sandro S, Mosconi C, Vicentin I et al. Including mRECIST in the Metroticket 2.0 criteria improves prediction of hepatocellular carcinoma-related death after liver transplant. J Hepatol. 2020; 73 (2): 342–348. doi: 10.1016/j.jhep.2020.03.018.

11. Bagatelia ZA, Dukhanina IV. Analiz hirurgicheskoj pomo­ shchi bol’nym s zabolevanijami organov brjushnoj polosti. Vrach-aspirant. 2015; 69 (2.2): 208–212.