Echinococcal Liver Infections: Comparing Transplant Strategies for Granulosus and Alveolaris

Abstract

Objective. This study aims to evaluate liver transplantation strategies for patients with Echinococcus granulosus (EG) and Echinococcus alveolaris (EA), comparing surgical approaches, complications, and outcomes in both groups. Methods. A retrospective analysis was conducted on 11 patients who underwent liver transplantation for EG or EA at our center between 2006 and 2024. Patient data included demographics, surgical details, preoperative and postoperative management, and follow-up outcomes. Results. All EG patients presented with cirrhosis, primarily due to treatment-related complications, while EA patients exhibited diffuse parenchymal and hilar involvement. Transplantation in EG cases was performed to address complications, whereas EA cases required transplantation due to the disease's malignant behavior and advanced liver involvement. All patients underwent living donor liver transplantation, with inferior vena cava (IVC) plasty performed in 2 EA patients. No recurrence was observed in either group during follow-up. Mortality was reported in 2 EG patients: 1 due to early postoperative complications and another from leukemia 2 years post-transplant. EA patients achieved excellent outcomes, with no mortality or recurrence observed during a mean follow-up period of 10 years. Conclusions. Liver transplantation is a safe and effective treatment for EG and EA, requiring distinct strategies tailored to each disease. EG transplants are typically performed to manage complications, whereas EA transplants necessitate advanced surgical techniques, including minimal liver manipulation and IVC plasty. These findings emphasize the critical role of specialized centers and tailored strategies in managing complex echinococcal liver infections.