Liver transplantation for hepatic alveolar echinococcosis: literature review and three new cases

Background: Echinococcosis is a helminthic infection caused by ingestion of the eggs of the parasitic metacestode of one of four members of the Echinococcus genus. Among them, hepatic alveolar echinococcosis (HAE) mimics slow growing liver tumour with subsequent invasion to liver tissues and metastatic dissemination. Liver transplantation (LT) remains as the only treatment option when the lesions exceed the resectability limits. We described the first three cases of HAE who underwent orthotopic LT in Iran. A literature review was also conducted to summarize experiences of different transplant centres around the world.Methods: PubMed, Scopus and Web of Science databases were searched up to April 2017 using keywords related to echinococcosis, liver and transplantation.Results: Including this case report, a total of 150 patients underwent LT due to echinococcosis from 1994 to 2017. The mean age at LT was 38 years (range: 12-71) and 51% were male. About 95% of the transplantations were performed due to HAE. Pre- and post-transplant benzimidazole therapy was considered in 69% and 73% of patients, respectively. Recurrence rate varied between 0% and 60%. The overall 1-, 5- and 10-year survival rates were 60-100%, 67-85% and 49-75%, respectively.Conclusions: LT combined with pre- and post-transplant benzimidazole therapy appears to be feasible and effective for patients with fatal HAE.