World journal of transplantation · 2026
Adrenal metastasis of hepatocellular carcinoma after liver transplantation: Case report and systematic review of literature.
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Ramia José Manuel, Franco Mariano, Alcázar Cándido, Carbonell-Morote Silvia, Rubio-García Juan Jesús, Rodríguez María, Pascual Sonia, Melgar Paola, Villodre Tudela Celia
Аннотация
BACKGROUND: Adrenal metastasis of hepatocellular carcinoma (AM-HCC) after liver transplantation (LT) is an infrequent entity, especially when it is the only site of recurrence. We present patients with these characteristics and systematically review previously published cases. No systematic review adhering to PRISMA criteria has been previously performed.
AIM: To systematic review of isolated AM-HCC after LT.
METHODS: Adhering to PRISMA guidelines, we performed unrestricted search for AM-HCC after LT in several databases, with no language restriction, updated through December 31, 2024.
RESULTS: We obtained 38 articles. Only 14 articles, comprising 20 patients, were evaluated, to which we added our own case. Fourteen were single-case reports, and one was a series of seven retrospective cases. The median age was 56.1 years [interquartile range (IQR): 23-72]. The gender distribution was predominantly male (84.6%). The indications for LT were hepatocellular carcinoma (HCC) plus hepatitis B virus cirrhosis (11), hepatitis C virus (6), alcohol (3), and cryptogenic cirrhosis (1). The median HCC tumor size was 4.6 cm (IQR: 3.8-13). One third of patients did not meet the Milan criteria. The median time between LT and the appearance of adrenal metastasis (AM) was 39.9 months (IQR: 18-42.6). The AM was located on the left (11) and right side (10). Nineteen patients were treated with adrenalectomy, and two were treated with radiotherapy. After a median follow-up of 30 months, 25% of patients were alive without recurrence. The median survival time was 29 months (IQR: 24-38).
CONCLUSION: In the case of AM-HCC after LT, occurring as the solitary site of extrahepatic metastasis, adrenalectomy could be a therapeutic option for surgical candidates. It is safe, appears to increase survival, and reduces recurrence in selected patients.
AIM: To systematic review of isolated AM-HCC after LT.
METHODS: Adhering to PRISMA guidelines, we performed unrestricted search for AM-HCC after LT in several databases, with no language restriction, updated through December 31, 2024.
RESULTS: We obtained 38 articles. Only 14 articles, comprising 20 patients, were evaluated, to which we added our own case. Fourteen were single-case reports, and one was a series of seven retrospective cases. The median age was 56.1 years [interquartile range (IQR): 23-72]. The gender distribution was predominantly male (84.6%). The indications for LT were hepatocellular carcinoma (HCC) plus hepatitis B virus cirrhosis (11), hepatitis C virus (6), alcohol (3), and cryptogenic cirrhosis (1). The median HCC tumor size was 4.6 cm (IQR: 3.8-13). One third of patients did not meet the Milan criteria. The median time between LT and the appearance of adrenal metastasis (AM) was 39.9 months (IQR: 18-42.6). The AM was located on the left (11) and right side (10). Nineteen patients were treated with adrenalectomy, and two were treated with radiotherapy. After a median follow-up of 30 months, 25% of patients were alive without recurrence. The median survival time was 29 months (IQR: 24-38).
CONCLUSION: In the case of AM-HCC after LT, occurring as the solitary site of extrahepatic metastasis, adrenalectomy could be a therapeutic option for surgical candidates. It is safe, appears to increase survival, and reduces recurrence in selected patients.