Liver Transplantation for Hepatocellular Carcinoma

Abstract Hepatocellular carcinoma (HCC) is the most common primary malignancy of the liver and is associated with very poor overall survival. Most patients present with advanced-stage disease and are therefore not eligible for curative surgical therapies. In patients who do present with early-stage HCC, liver transplantation (LT) is an optimal curative surgical option, if the patient is eligible for LT. Most HCC develops in the background of chronic liver disease, and LT serves as a treatment for both the cancer and the underlying cirrhosis. Although the initial experience with LT for HCC was associated with a high recurrence rate and poor survival, it was later demonstrated that by limiting LT to patients with early-stage disease, excellent long-term survival could be attained. A set of size criteria termed Milan criteria (single tumor ≤5 cm or three or more tumor nodules, each ≤3 cm) has been established as the size and number cut off associated with the best post-transplant outcome for patients with HCC. Despite strict selection criteria, recurrence of HCC does occur in 10–15 % of patients. Multiple different locoregional therapies and systemic therapies such as sorafenib are being employed to prevent recurrence in patients with aggressive phenotypes but their efficacy has not been well established.
Source: Current Transplantation Reports - Category: Transplant Surgery Source Type: research