Percutaneous Microwave Ablation of Hepatocellular Carcinoma As Bridge-to-Transplant Therapy in a High-Risk Patient With Alpha-1 Antitrypsin Deficiency and Factor V Leiden Mutation: A Case Report

The use of percutaneous microwave ablation has been established as a treatment for early-stage hepatocellular carcinoma (HCC). HCC can often arise in the setting of cirrhosis and often requires locoregional therapy to ablate the area as a bridge for the ultimate treatment of liver transplantation. The challenge is its use in patients with decompensated cirrhosis and hypercoagulable states, as these high-risk populations can lead to other major complications, requiring anticoagulation, which remains challenging. In this case report, a 60-year-old woman with a history of alpha-1 antitrypsin deficiency-related cirrhosis presented with Child-Pugh class B (score 9) liver disease, thrombocytopenia, portal hypertension with esophageal varices, and factor V Leiden mutation. She underwent successful image-guided microwave ablation of a segment 7/8 Liver Imaging Reporting and Data System (LI-RADS) 5 HCC lesion as a bridge to liver transplantation, performed by interventional radiology. In this ablation, she had significant procedural risk factors, but with multidisciplinary planning, there was only a minor non-distressing hematoma noted, and overall allowed effective tumor treatment without major complications. This case highlights the practicality of microwave ablation in high-risk patients and emphasizes the critical role of interventional radiology in expanding therapeutic options for transplant candidates with limited alternatives.