Ex vivo Liver Autotransplantation for Alveolar Echinococcosis with Brain and Lung Metastases: A Case Report

Ex vivo liver resection and autotransplantation (ELRA) in extensive abdominal alveolar echinococcosis (AE) is a relatively rare treatment. We present the first case, ever reported in Kazakhstan, of successfully performed ELRA of a patient with extensive abdominal AE with invasion into the inferior vena cava (IVC). A 64-year-old woman was diagnosed with AE of the brain, alveococcectomy from the left frontal lobe was performed. At the same time, liver AE metastased to the lungs and brain was diagnosed. The patient was admitted to our center for the following surgical treatments: (1) laparotomy, (2) extended left hemihepatectomy with resection of IVC ex vivo, (3) plastic surgery of IVC with a synthetic prosthesis, (4) orthotopic transplantation of the remnant right lobe of the liver. The postoperative period proceeded smoothly. The patient was mechanically ventilated for 1.5 days and prescribed strict bed rest with in-bed activity for up to 11 days. Empirical antibiotic therapy was initiated as follows: meropenem 1000 mg three times a day for 10 days, omeprazole 40 mg once a day for 14 days, anticoagulant therapy was not administered in the first post-operation day due to high risk of bleeding. Clexane was prescribed subcutaneously once a day: 0.2 mL for 2 days, then 0.4 mL for next 10 days. Daily transfusion of 100 mL of 10% Albumin was performed to prevent hypoalbuminemia. Drainage systems were removed on the 9th day. On the 12th day, the patient was transferred from the intensive care unit to a hospital room, and discharged with improvement on the 20th day. During a 6-month follow-up, no relapse was observed. Radical surgery for widespread AE, in this case - ELRA, is the preferred treatment, since it does not require immunosuppressive therapy and is quite feasible even with invasion of the portal vein bifurcation, IVC and hepatocaval confluence.