Successful outcome after transplantation of a donor liver with focal nodular hyperplasia

Because of the increasing gap in the number of patients awaiting organ tran splantation and the supply of organ donors, reevaluation of donor criteria is an important issue in clinical transplantation, It has become necessary to make maximal use of the currently available donor pool. We describe a ca se of successful orthotopic liver transplantation in a 57-pear-old man with Laennec's cirrhosis using a liver containing an 8-cm focal nodular hyperpl asia (FNH) lesion involving segments II and III and the caudate lobe. The d onor liver was procured from a 46-year-old woman declared brain dead after a subarachnoid hemorrhage, Definitive pathological diagnosis was made at la parotomy by obtaining a Tru-cut (Allegiance Health Care Inc, Toronto, Ontar io, Canada) core biopsy specimen. The recipient operation was performed une ventfully except for bleeding from the biopsy site. The patient did well po stoperatively and was discharged on tacrolimus, mofetil mycophenolate, and prednisone therapy, He continues to thrive 2(1)/(2) years posttransplantati on with no change in the size of the lesion. In well-selected donors,. FNH should not be a contraindication for use in transplantation, However, FNH m ust be differentiated from hepatocellular adenoma, Although FNH has a benig n course with little propensity for bleeding and almost no malignant potent ial, hepatic adenoma is reported to have a 15% to 33% chance of bleeding an d rupture with a well-documented potential for neoplastic degeneration, mak ing the liver unsuitable for donation.