Introduction : Biliary obstruction is a common morbidity after liver transplantation. The anastomotic failure of biliary reconstruction is the leading cause. When the patient with hepatocellular carcinoma (HCC) underwent liver trasplantation and developed a jaundice, the recurrence of HCC is suggested as the main cause.

Methods : Here we describes a case of biliary obstruction due to pancreatic head cancer at 11 months after LDLT. The patient was a 54-year-old male with HBV related cirrhosis and hepatocellula carcinoma (HCC) within Milan criteria. Our patient previously underwent liver resection for HCC two times in 1998 and 2002. Recurrence of HCC revealed and LDLT using the right lobe from his 23-year-old daughter was performed in December 2008. Immnosuppressive treatment was administered with basiliximab, tacrolimus, corticosteroids and mycophenolate mofetil. He discharged on postoperative 28th day with uncomplicated course.

Results : At eleven months after operation, the patient showed icterus. Ampullary stricture below the anastomosis site was found by MRCP and finally diagnosed in adenocarcinoma with endoscopic biopsy. Pylorus-preserving pancreaticoduodenectomy (PPPD) was performed for complete resection of pancreatic head cancer on 14 months after LDLT. The patient revealed favorable outcomes except for superior mesenteric arterial (SMA) pseudoaneurysmal bleeding controlled by endovascular graft postoperatively. However, the patient died from recurred pancreatic head cancer two year after LDLT.

Conclusions : Our experience suggest that high suspicion of de novo malignancy is needed for the patient with HCC who has undergone liver transplantation.