{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T13:56:16Z","timestamp":1775138176318,"version":"3.50.1"},"reference-count":15,"publisher":"BMJ","issue":"11","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,10,15]]},"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:p>This case report describes two patients with congenital heart disease (CHD) who underwent Fontan palliation surgery in their youth and subsequently developed Fontan-associated liver disease (FALD) in adulthood. While undergoing routine screening for hepatocellular carcinoma (HCC), both patients had significantly elevated serum alpha-fetoprotein testing and diagnostic radiographic findings consistent with early-stage HCC. At the same academic medical centre, both patients were treated with localised yttrium-90 (Y90) radioembolisation therapy, and neither underwent liver transplantation (LT). After Y90 radioembolisation, both patients achieved HCC remission that has sustained at 3 years post-treatment. These cases suggest that Y90 radioembolisation may offer effective, transplant-free management of HCC in selected FALD patients. Given the growing adult FALD population, further studies are needed to guide surveillance and identify predictors of response to non-surgical therapies.<\/jats:p>","DOI":"10.1136\/bcr-2025-268253","type":"journal-article","created":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T04:10:15Z","timestamp":1762402215000},"page":"e268253","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Treatment of hepatocellular carcinoma in patients with Fontan-associated liver disease with radioembolisation therapy"],"prefix":"10.1136","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9623-6792","authenticated-orcid":false,"given":"Rachel","family":"Orbuch","sequence":"first","affiliation":[{"name":"Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Ganger","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amir","family":"Borhani","sequence":"additional","affiliation":[{"name":"Department of Radiology (Abdominal Imaging) and Surgery (Organ Transplant), Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert J","family":"Lewandowski","sequence":"additional","affiliation":[{"name":"Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago, Illinois, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dempsey","family":"Hughes","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,11,5]]},"reference":[{"key":"2026040206100842000_18.11.e268253.1","doi-asserted-by":"publisher","DOI":"10.1016\/0003-4975(91)91044-V"},{"key":"2026040206100842000_18.11.e268253.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jjcc.2019.02.016"},{"key":"2026040206100842000_18.11.e268253.3","doi-asserted-by":"publisher","DOI":"10.1136\/jcp.2007.052365"},{"key":"2026040206100842000_18.11.e268253.4","doi-asserted-by":"crossref","first-page":"1057","DOI":"10.1093\/eurheartj\/ehy620","article-title":"The clinical spectrum of Fontan-associated liver disease: results from a prospective multimodality screening cohort","volume":"40","author":"Munsterman","year":"2019","journal-title":"Eur Heart J"},{"key":"2026040206100842000_18.11.e268253.5","doi-asserted-by":"crossref","first-page":"4467","DOI":"10.1007\/s10620-024-08470-1","article-title":"A Meta-Analysis of Cumulative Incidence of Hepatocellular Carcinoma After the Fontan Operation","volume":"69","author":"Hansen","year":"2024","journal-title":"Dig Dis Sci"},{"key":"2026040206100842000_18.11.e268253.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2018.08.1029"},{"key":"2026040206100842000_18.11.e268253.7","doi-asserted-by":"crossref","DOI":"10.1016\/j.jacadv.2025.101646","article-title":"Characteristics and Survival Outcomes of Hepatocellular Carcinoma After the Fontan Operation","volume":"4","author":"Rosenthal","year":"2025","journal-title":"JACC Adv"},{"key":"2026040206100842000_18.11.e268253.8","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.120.045597"},{"key":"2026040206100842000_18.11.e268253.9","doi-asserted-by":"crossref","unstructured":"Singal AG , Parikh ND , Rich NE , et al . Hepatocellular carcinoma surveillance and staging. In: Hoshida Y , ed. Hepatocellular carcinoma: translational precision medicine approaches. 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