Liver Transplantation for Diffuse Infantile Hepatic Hemangioma and Acute Liver Failure: A Case Report.
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BACKGROUND: Diffuse infantile hepatic hemangiomas can lead to complications such as high-output heart failure, hypothyroidism, abdominal compartment syndrome, and hepatic failure. Medical management with propranolol is first-line therapy; however, treatment failure may occur in severe cases. METHODS: We described the case of a 2-month-old male with multiple cutaneous infantile hemangiomas and diffuse hepatic hemangiomas who presented with acute liver failure and cardiorespiratory insufficiency despite optimal treatment with propranolol. The patient was urgently listed for liver transplantation with a Pediatric End-Stage Liver Disease (PELD) score of 23 and weight < 5 kg. The infant underwent orthotopic liver transplantation from a deceased donor with caval replacement. RESULTS: Immunohistochemical staining of the liver and adrenal lesions was diffusely and strongly positive for GLUT1, consistent with infantile hemangioma. Liver function labs normalized immediately post-operatively without perioperative complications or rejection. The patient is growing and developing normally at 10 months after transplant. CONCLUSIONS: This case highlights liver transplantation as a definitive treatment for hemangioma-related acute liver failure when propranolol therapy fails. Timely referral for transplantation is critical in optimizing outcomes in this rare but severe condition.