Can Med Assoc J 1976 Oct 9;115(7):615-9

Liver transplantation in a patient with cholangiocarcinoma and ulcerative
colitis

Abouna GM, Preshaw RM, Silva JL, Hollingsworth WJ, Hershfield NB, Novak W, Shaw DT, Vetters JM

Abstract
A 39 year-old patient with cholangiocarcinoma and pre-existing ulcerative
colitis was successfully treated by orthotopic liver transplantation. He was
given low doses of prednisone and azathioprine and survived for more than 9
months, dying with tumour metastases, thrombosis of the inferior vena cava and
an intra-abdominal abscess. At autopsy the homograft showed little evidence of
rejection. Preoperatively the patient had septicemia. Removal of his liver was
difficult. The discrepancy between donor and recipient in size of blood vessels
and the presence of two hepatic arteries in the donor caused problems during the
vascular anastomoses. During the operation cardiac arrest occurred.
Postoperatively there were several medical and surgical problems, including
intraperitoneal and gastrointestinal hemorrhage, paralysis of the right dome of
the diaphragm, sinus bradycardia, massive diuresis, peroneal nerve palsy, and
one major and three minor episodes of rejection, which were reversed by giving
pulse doses of methylprednisolone intravenously