De Novo Hepatocellular Carcinoma in Primary Sclerosing Cholangitis Post-Liver Transplant: The Case for Surveillance

While recurrent primary sclerosing cholangitis and de novo malignancies such as skin cancer are common after liver transplantation, de novo hepatocellular carcinoma (HCC) after liver transplantation for primary sclerosing cholangitis is exceedingly rare.

A 72-year-old man with ulcerative colitis underwent liver transplantation for primary sclerosing cholangitis. Thirty years later, abdominal imaging incidentally revealed cirrhotic liver morphology with a new, bulky, and locally invasive hepatic mass. Biopsy confirmed stage IIIA hepatocellular carcinoma, which was treated successfully with Y-90 radioembolization segmentectomy.

Immunosuppression-related malignancies are prevalent in long-term liver transplant survivors, and HCC recurrence can occur in patients transplanted for HCC. However, de novo HCC is rare in liver transplant recipients with primary sclerosing cholangitis and has primarily been reported in patients with viral hepatitis.

Vigilant screening for allograft fibrosis, cirrhosis, and malignancy using emerging modalities in long-time liver transplant survivors warrants consideration.