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Role of Organ Transplantation in the Treatment of Malignancies – Hepatocellular Carcinoma as the Most Common Tumour Treated with Transplantation

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Pathology & Oncology Research

Abstract

There are only few malignant tumours where organ transplantation is the treatment of choice. Transplantation can be considered individually in certain lung carcinomas, unresectable heart tumours, cholangiocellular carcinoma and Klatskin tumour. It is acceptable in unresectable chemosensitive hepatoblastoma, epitheloid haemangioendothelioma, liver metastasis of neuroendocrine tumours and as the most common indication, the early hepatocellular carcinoma (HCC) in cirrhotic liver. Results of liver transplantation (LT) for HCC according to Milan criteria as a “gold standard” are excellent. Time of LT has a great influence on the results. While patients are on waiting list, locoregional therapies may help prevent tumour progress. Living donor LT is an acceptable treatment of HCC. The greatest experience with this procedure is in Asia. Despite the favourable results, LT as the treatment of HCC is debated and raises several questions: regarding indication and expectable outcome. Milan criteria seem to answer this questions although they are too strict. The number and size of HCC foci per se is not sufficient predictor of eligibility to transplantation and for prognosis. Majority of the prognostic factors can be evaluated only after transplantation with pathological examination of HCC. Aim of the present research is to find prognostic factors that are characteristic of biological behaviour of HCC, which can be detected before LT in order to select patients who have the greatest benefit from LT. Re-definition of eligibility criteria is an actual question; an international consensus based on additional prospective studies is required for the “new” recommendation.

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Abbreviations

AASLD:

Association for the Study of Liver Diseases

AFP:

Alpha-fetoprotein

AU:

Arbitrary unit

BAC:

Bronchioloalveolar carcinoma

DCP:

Des-gamma-carboxy prothrombin

FDG-PET:

Fluorodeoxyglucose positron emission tomography

HCC:

Hepatocellular carcinoma

INR:

International normalized ratio for prothrombin time

LDLT:

Living donor liver transplantation

LRT:

Locoregional therapies

LT:

Liver transplantation

MC:

Milan criteria

MELD:

Model for end-stage liver disease

UCSF:

University of California San Francisco

PEI:

Percutaneous ethanol injection

PIVKA:

Protein induced by vitamin K absence or antagonist

RFA:

Radiofrequency ablation

SHARP:

Sorafenib HCC Assessment Randomized Protocol

SUVmax:

Maximum standardized uptake value

TACE:

Transarterial chemoembolization

TARE:

Transarterial radioembolization

TTV:

Total tumor volume

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Authors and Affiliations

  1. Department of Transplantation and Surgery, Semmelweis University, Baross u. 23., Budapest, 1082, Hungary

    Gyula Végső, Dénes Görög, Imre Fehérvári, Balázs Nemes, Attila Doros, Róbert Miklós Langer & László Kóbori

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  1. Gyula Végső
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  2. Dénes Görög
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Correspondence to Gyula Végső.

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Végső, G., Görög, D., Fehérvári, I. et al. Role of Organ Transplantation in the Treatment of Malignancies – Hepatocellular Carcinoma as the Most Common Tumour Treated with Transplantation. Pathol. Oncol. Res. 18, 1–10 (2012). https://doi.org/10.1007/s12253-011-9441-4

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