RIGHT-LOBE LIVING DONOR LIVER TRANSPLANTATION FOR HEPATOCELLULAR CARCINOMA WITH DECOMPENSATED CIRRHOSIS: THE FIRST CASE AT THONG NHAT HOSPITAL

Lê Đình Thanh 1 , Đỗ Kim Quế 1 , Võ Thành Toàn 1 , Nguyễn Quang Vinh 1 , Nguyễn Khánh Vân 1 , Nguyễn Xuân Hoà 1 , Phạm Công Khanh 1 , Lê Thanh Nghị 1 , Lê Hiếu 1 , Nguyễn Hải Nam 1 ,
1 Thong Nhat Hospital image/svg+xml
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DOI
10.63947/bvtn.v2i9.1
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Published
2026-10-01
Issue Vol. 2 No. 9 (2026): A Major Step Forward in Specialized Care: A Milestone Marked by the First Liver Transplant at Thong Nhat Hospital
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Case Report

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Lê ĐT, Đỗ KQ, Võ TT, Nguyễn QV, Nguyễn KV, Nguyễn XH, Phạm CK, Lê TN, Lê H, Nguyễn HN. RIGHT-LOBE LIVING DONOR LIVER TRANSPLANTATION FOR HEPATOCELLULAR CARCINOMA WITH DECOMPENSATED CIRRHOSIS: THE FIRST CASE AT THONG NHAT HOSPITAL. JHA [Internet]. Vietnam; 2026 Oct. 1 [cited 2026 Oct. 16];2(9):1–10. https://tcsuckhoelaohoa.vn/bvtn/article/view/252 doi: 10.63947/bvtn.v2i9.1
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Abstract

Living donor liver transplantation (LDLT) is a potentially curative treatment for hepatocellular carcinoma (HCC) in patients with decompensated cirrhosis, particularly in countries with limited availability of deceased-donor organs. We report the first LDLT performed at Thong Nhat Hospital, Ho Chi Minh City, Vietnam. A 50-year-old man had a solitary 4.8-cm HCC within the Milan criteria on a background of Child–Pugh class C cirrhosis (MELD score, 18) associated with hepatitis B and C virus coinfection. He also had type 2 diabetes mellitus. His healthy 29-year-old brother, who was ABO-compatible, served as the living donor, and a right-lobe graft was used. Clinical, biochemical, and imaging findings were followed from the preoperative period through postoperative day (POD) 16. The operation was completed in 8 hours. Serum lactate decreased substantially within the first 12 hours and normalized by POD 2. Aspartate aminotransferase peaked at 474 U/L on POD 2 and alanine aminotransferase at 626 U/L on POD 3, followed by a progressive decline. Between POD 7 and POD 10, a secondary increase in aminotransferases, gamma-glutamyl transferase, and direct bilirubin occurred. Doppler ultrasonography and computed tomography showed no vascular thrombosis or biliary dilatation. CT demonstrated mild hepatic artery anastomotic narrowing, while the available Doppler measurements did not suggest a clear hemodynamic impact; drain-fluid bilirubin did not suggest a bile leak. Biochemical indices improved after optimization of immunosuppressive therapy; however, liver biopsy was not performed to confirm rejection. By POD 16, prothrombin activity was 82% and the platelet count was 122 × 10⁹/L; the most recent serum albumin level was 42.7 g/L on POD 15. The donor recovered uneventfully and was discharged on POD 12. No vascular thrombosis, bile leak, severe infection, or biopsy-proven rejection was documented during the observation period. This case demonstrates the initial feasibility of establishing an LDLT program at Thong Nhat Hospital. Multidisciplinary preparation and technical collaboration with 108 Military Central Hospital were important contributors to the favorable early outcome. Longer follow-up and additional cases are required to establish the safety and effectiveness of the program.

Keywords

living donor liver transplantation hepatocellular carcinoma decompensated cirrhosis case report technical transfer

References

  1. Lee SG. A complete treatment of adult living donor liver transplantation: a review of surgical technique and current challenges to expand indication of patients. Am J Transplant. 2015;15(1):17-38. DOI: https://doi.org/10.1111/ajt.12907
  2. Chen CL, Kabiling CS, Concejero AM. Why does living donor liver transplantation flourish in Asia? Nat Rev Gastroenterol Hepatol. 2013;10(12):746-751. DOI: https://doi.org/10.1038/nrgastro.2013.194
  3. Lê Thế Trung, Phạm Gia Khánh, Nguyễn Tiến Bình, Hoàng Văn Lương, Hoàng Mạnh An, Lê Trung Hải, và cs. Thành tựu 20 năm ghép tạng tại Bệnh viện 103, Học viện Quân y. Tạp chí Y Dược học Quân sự. 2012;(Số chuyên đề Ghép tạng):15-20.
  4. Cục Thông tin và Truyền thông Chính phủ. Thúc đẩy hệ thống hiến-ghép tạng bền vững tại Việt Nam [Internet]. Báo Điện tử Chính phủ; 2026 Jan 10 [cited 2026 Sep 17]. Available from: https://baochinhphu.vn/thuc-day-he-thong-hien-ghep-tang-ben-vung-tai-viet-nam-102260110163934926.htm
  5. Đinh Hằng. Thêm cơ sở thực hiện ghép gan, mở ra cơ hội sống cho người bệnh ung thư [Internet]. VietnamPlus. 2026 Sep 8 [cited 2026 Sep 17]. Available from: https://www.vietnamplus.vn/them-co-so-thuc-hien-ghep-gan-mo-ra-co-hoi-song-cho-nguoi-benh-ung-thu-post1134878.vnp
  6. Gagnier JJ, Kienle G, Altman DG, Moher D, Sox H, Riley D; CARE Group. The CARE guidelines: consensus-based clinical case reporting guideline development. Headache. 2013;53(10):1541-1547. DOI: https://doi.org/10.1111/head.12246
  7. Mazzaferro V, Regalia E, Doci R, Andreola S, Pulvirenti A, Bozzetti F, et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med. 1996;334(11):693-9. doi: 10.1056/NEJM199603143341104 DOI: https://doi.org/10.1056/NEJM199603143341104
  8. Lee SG, Park KM, Hwang S, et al. Modified right liver graft from a living donor to prevent congestion. Transplantation. 2002;74(1):54-59. DOI: https://doi.org/10.1097/00007890-200207150-00010
  9. Olthoff KM, Kulik L, Samstein B, et al. Validation of a current definition of early allograft dysfunction in liver transplant recipients and analysis of risk factors. Liver Transpl. 2010;16(8):943-949. DOI: https://doi.org/10.1002/lt.22091
  10. Henson JB, Muir AJ. Evaluation of an abnormal liver panel after liver transplantation. Clin Liver Dis. 2023;27(1):103-115. doi:10.1016/j.cld.2022.08.006. DOI: https://doi.org/10.1016/j.cld.2022.08.006
  11. Rodríguez-Perálvarez M, Germani G, Darius T, et al. Tacrolimus trough levels, rejection and renal impairment in liver transplantation: a systematic review and meta-analysis. Am J Transplant. 2012;12(10):2797-2814. DOI: https://doi.org/10.1111/j.1600-6143.2012.04140.x
  12. Demetris AJ, Bellamy C, Hübscher SG, et al. 2016 Comprehensive update of the Banff Working Group on liver allograft pathology: introduction of antibody-mediated rejection. Am J Transplant. 2016;16(10):2816-2835. DOI: https://doi.org/10.1111/ajt.13909
  13. Vu QV, Le TV, Le HT, Nguyen AHN, Nguyen DT. Adult-to-adult right lobe graft living donor liver transplantation for acute-on-chronic liver failure: a single-centre retrospective study in Vietnam. Ann Med Surg (Lond). 2024;86(3):1261-1267. DOI: https://doi.org/10.1097/MS9.0000000000001708
  14. Dogan N, Hüsing-Kabar A, Schmidt HH, Cicinnati VR, Beckebaum S, Kabar I. Acute allograft rejection in liver transplant recipients: incidence, risk factors, treatment success, and impact on graft failure. J Int Med Res. 2018;46(9):3979-3990. doi: 10.1177/0300060518785543 DOI: https://doi.org/10.1177/0300060518785543
  15. Shaked A, Ghobrial RM, Merion RM, Shearon TH, Emond JC, Fair JH, et al. Incidence and severity of acute cellular rejection in recipients undergoing adult living donor or deceased donor liver transplantation. Am J Transplant. 2009;9(2):301-308. doi:10.1111/j.1600-6143.2008.02487.x. DOI: https://doi.org/10.1111/j.1600-6143.2008.02487.x
  16. Li Z, Rammohan A, Gunasekaran V, Hong S, Chen IC, Kim J, et al. Biliary complications after adult-to-adult living-donor liver transplantation: an international multicenter study of 3633 cases. Am J Transplant. 2024;24(7):1233-1246. doi: 10.1016/j.ajt.2024.02.023 DOI: https://doi.org/10.1016/j.ajt.2024.02.023
  17. Kim SH, Cho SY, Park SJ, Lee KW, Han SS, Lee SA, et al. Learning curve for living-donor liver transplantation in a fledgling cancer center. Transpl Int. 2009;22(12):1164-1171. doi: 10.1111/j.1432-2277.2009.00934.x DOI: https://doi.org/10.1111/j.1432-2277.2009.00934.x

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