Highlights in liver transplantation

Right Hepatic Lobe Donation Adversely Affects Donor Life Insurability Up to One Year After Donation

Nissing and Hayashi called ten agents of ten different large life insurance companies for premium quotes on a $100,000 term life policy and provided two profiles: one of a person who had been a live right lobe liver donor and another person with a similar profile but without donation background. The person without a donation background unanimously received the lowest, “preferred” rate in all ten companies. Five of the ten companies would do the same with the fictitious customer with donation background. However, one of the other five agents would not underwrite a policy for a customer with donation background.

The authors also noted other barriers for the one with donation background, this potential customer also was quoted higher premiums and required more phone calls. This publication is a first attempt to address a potentially important issue among living donors. Potential living donors should be made aware of this possibility and we, as a community dedicated to organ transplantation should assist in changing erroneous perceptions that may affect organ donation. This article is accompanied by an editorial by Dr. Elizabeth Pomfret. (SEE Liver Transplantation 2005;11:843-847.)

Hepatic B-Cell Non-Hodgkin's Lymphoma of MALT Type in the Liver Explant of a Patient With Chronic Hepatitis C Infection Liver Transplantation for HCV-Related Cirrhosis in a Patient With Gastric Mucosa-Associated Lymphoma (MALToma) Pretreated With Rituximab

These two publications address an uncommon association. Vargas et al. reported the incidental finding of a hepatic B-cell non-Hodgkin's lymphoma of MALT type in the explant of a patient with chronic hepatitis C. Foxton et al. reported the successful treatment of a gastric mucosa-associated lymphoma (MALToma) with rituximab prior to liver transplantation and subtotal gastrectomy, five months after transplantation.

The patient with gastric MALToma was also infected with Helicobacter pylori. Affected tissue also had HCV-RNA sequences present which was not the case with unaffected mucosa; the significance of this association remains speculative.

The association between H. pylori and gastric MALToma is well established. The association between HCV and MALToma is less well characterized. The report by Vargas et al. is the first one to establish the association between hepatic MALT type B non-Hodgkin lymphoma and chronic HCV infection. This patient was also treated with rituximab. Both publications speculate on the potential role that antiviral therapy may play in this condition. The concern is that the efficacy of antiviral therapy will be diminished in the presence of immunosuppression. Both publications are accompanied by an editorial by Dr. Nalesnik in which he speculates on the development of a MALToma in the presence of HCV and H. pylori infections. (SEE Liver Transplantation 2005;11:796-799 and 839-842.)