Because of the increasing gap in the number of patients awaiting
organ transplantation 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 case of successful orthotopic
liver transplantation in a 57-year-old man with Laënnec's
cirrhosis using a liver containing an 8-cm
focal nodular hyperplasia (FNH) lesion involving segments II and III and the caudate lobe. The donor liver was procured from a 46-year-old woman declared
brain dead after a
subarachnoid hemorrhage. Definitive pathological diagnosis was made at
laparotomy by obtaining a Tru-cut (Allegiance Health Care Inc, Toronto, Ontario, Canada) core biopsy specimen. The recipient operation was performed uneventfully except for
bleeding from the biopsy site. The patient did well postoperatively and was discharged on
tacrolimus,
mofetil mycophenolate, and
prednisone therapy. He continues to thrive 2(1/2) years posttransplantation 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 must be differentiated from
hepatocellular adenoma. Although FNH has a benign course with little propensity for
bleeding and almost no malignant potential, hepatic
adenoma is reported to have a 15% to 33% chance of
bleeding and
rupture with a well-documented potential for neoplastic degeneration, making the liver unsuitable for donation.