Rupture of Hepatic Hemangioma Following Living Donor Liver Transplantation: A Case Report

Hepatic hemangiomas are common benign liver tumors, typically asymptomatic with a low complication rate in liver transplantation (LT). However, post-transplant rupture, though rare, can result in significant morbidity. This report describes the rupture of a small hepatic hemangioma in a liver graft following pediatric living donor liver transplantation (LDLT).

An 11-month-old boy with biliary atresia underwent LDLT using a left lateral segment from his healthy mother. Preoperative imaging revealed a 2x3 cm hemangioma in Segment III of the donor's liver. Post-transplant, the child experienced significant bleeding 4 h after surgery, leading to hemodynamic instability and a drop in hemoglobin. Re-exploration revealed a large hematoma and rupture at the hemangioma site. Additional resection of the hemangioma and hematoma was performed. The child recovered after a prolonged ICU stay and remains well after 8 years of follow-up.

Hepatic hemangiomas are generally asymptomatic, but rupture post-transplant can lead to severe complications. There is no standardized approach for managing hemangiomas in liver grafts. This case highlights the need for careful evaluation of lesion size, location, and potential vascular and biliary implications in donor selection. Further research is needed to define optimal management strategies for liver graft hemangiomas.

While rare, hepatic hemangiomas in liver grafts require careful evaluation, with further studies needed to establish management protocols.