Cancer Chemotherapy and Pharmacology

, Volume 31, Supplement 1, pp S157–S161 | Cite as

Liver transplantation for hepatocellular carcinoma: clinical results and future aspects

  • Rudolf Pichlmayr
  • Arved Weimann
  • Gustav Steinhoff
  • Burckhardt Ringe
Plenary Session: State of the Art in Liver Cancer HBV, HCV Hepatocellular Carcinoma


The treatment of unresectable hepatocellular carcinoma (HCC) by liver transplantation remains controversial. In our series, the 5-year survival value for 87 patients who underwent transplantations between 1972 and 1990 was 19.6%. There was no difference in the longterm survival of patients who had underlying cirrhosis and those who did not. In patients with early-stage tumours the long-term prognosis was improved, the 5-year survival in stage II disease being 55.6% according to UICC criteria. Even in some cases of more advanced tumour stage, good long-term results were obtained. In a review of the recent literature, we evaluated prognostic factors to work out criteria for a more differentiated indication for liver transplantation. Resection of increased radicality-which will keep its place as the therapy of choice — and transplantation should be performed complementarily. Further developments will reveal the value of multimodal therapeutic strategies, including chemo-embolisation, chemotherapy and immunotherapy.


Carcinoma Clinical Result Prognostic Factor Hepatocellular Carcinoma Liver Transplantation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Bengmark S, Hafström L, Jeppson B, Sundqvist K (1982) Primary carcinoma of the liver: improvement in sight? World J Surg 6:54Google Scholar
  2. 2.
    Berman MM, Burnham JA, Sheahan DG (1988) Fibrolamellar carcinoma of the liver: an immunohistological study of nineteen cases and a review of the literature. Hum Pathol 19:784Google Scholar
  3. 3.
    Bismuth H, Houssin D, Ornowski J, Meriggi F (1986) Liver resections in cirrhotic patients: a Western experience. World J Surg 10:311Google Scholar
  4. 4.
    Bismuth H, Castaing G, Ericzon BG, Otte JB, Rolles K, Ringe B, Slooff M (1987) Hepatic transplantation in Europe: first report of the European Liver Transplant Registry. Lancet II:674Google Scholar
  5. 5.
    Bismuth H, Castaing D, Garden OJ (1987) The use of operative ultrasound in surgery of primary liver tumors. World J Surg 11:610Google Scholar
  6. 6.
    Bismuth H, Adam R, Castaing D, Chiche L, Ceriello A (1989) Results of liver transplantation (OLT) in hepatocellular carcinoma (HCC). In: IV Congress of the European Society for Organ Transplantation Book of Abstracts. November 1–4, 1989. Barcelona, p 42Google Scholar
  7. 7.
    Calne RY, Williams R (1968) Liver transplantation in man: 1. Observations on technique and organization in 5 cases. BMJ 4:535Google Scholar
  8. 8.
    Chen MF, Hwang TL, Yeng LBB, Jan YYJ, Wang CS, Chou FF (1989) Hepatic resection in 120 patients with hepatocellular carcinoma. Arch Surg 124:1025Google Scholar
  9. 9.
    Choi TK, Lai Edward CS, Fan ST, Mok Francis PT, Wong J (1990) Results of surgical resection for hepatocellular carcinoma. Hepatogastroenterology 37:172Google Scholar
  10. 10.
    Davidson AR, Tomlinson S, Calne RY, Williams R (1974) The variable course of primary hepatocellular carcinoma. Br J Surg 61:349Google Scholar
  11. 11.
    Doci R, Bignami P, Bozzetti F, Bonfanti G, Audisio R, Colombo M, Gennari L (1988) Intrahepatic chemotherapy for unresectable hepatocellular carcinoma. Cancer 61:1983Google Scholar
  12. 12.
    Funovics JM, Frisch A, Herbst F, Piza F, Mühlbacher F, Längle F, Schemper M (1988) Primary hepatic cancer — the role of limited resection and total hepatectomy with orthotopic liver replacement. Hepatogastroenterology 35:316Google Scholar
  13. 13.
    Goldie JH (1986) The rationale for perioperative chemotherapy based on the phenomenon of drug resistance. In: Jacquillat C, Weil M, Khayat D (eds) Neoadjuvant chemotherapy. (Colloque INSERM, John Libbey Eurotext, London, vol 137, p 23Google Scholar
  14. 14.
    Hermanek P, Sobin LH (1987) TNM classification of malignant tumors. Springer, Berlin Heidelberg New York London Paris TokyoGoogle Scholar
  15. 15.
    Ismail T, Angrisani L, Gunson BK, HÜbscher SG, Buckels JAC, Neuberger JM, Elias E, McMaster P (1990) Primary hepatic malignancy: the role of liver transplantation. Br J Surg 77:983Google Scholar
  16. 16.
    Iwatsuki S, Starzl TE (1988) Personal experience with 411 hepatic resections. Ann Surg 208:421Google Scholar
  17. 17.
    Iwatsuki S, Gordon RD, Shaw BW Jr, Starzl TE (1985) Role of liver transplantation in cancer therapy. Ann Surg 202:401Google Scholar
  18. 18.
    Jenkins RL, Wright Pinson C, Stone MD (1989) Experience with transplantation in the treatment of liver cancer. Cancer Chemother Pharmacol 23 [Suppl]:104Google Scholar
  19. 19.
    Kinami Y, Takashima S, Miyazaki I (1986) Hepatic resection for hepatocellular carcinoma associated with liver cirrhosis. World J Surg 10:294Google Scholar
  20. 20.
    Lin TY, Lee CS, Chen KM, Chen CC (1987) Role of surgery in the treatment of primary carcinoma of the liver: a 31-year experience. Br J Surg 74:839Google Scholar
  21. 21.
    Makuuchi M, Hasegawa H, Yamazaki S, Takayasu K, Moriyama N (1987) The use of operative ultrasound as an aid to liver resection in patients with hepatocellular carcinoma. World J Surg 11:615Google Scholar
  22. 22.
    O'Grady JG, Polson RJ, Rolles K, Calne RY, Williams R (1988) Liver transplantation for malignant disease. Ann Surg 207:373Google Scholar
  23. 23.
    Okuda K, Ohtsuki T, Obata H, Tomimatsu M, Okazaki N, Hasegawa H, Nakajima Y, Ohnishi K (1985) Natural history of hepatocellular carcinoma and prognosis in relation to treatment. Cancer 56:918Google Scholar
  24. 24.
    Olthoff KM, Millis JM, Rosove MH, Goldstein LI, Ramming KP, Busuttil RW (1990) Is liver transplantation justified for the treatment of hepatic malignancies? Arch Surg 125:1261Google Scholar
  25. 25.
    Pichlmayr R (1988) Is there a place for liver grafting for malignancy? Transplant Proc 20 [Suppl 1]:478Google Scholar
  26. 26.
    Pichlmayr R, Ringe B, Gubernatis G, Hauss J, Bunzendahl H (1988) Transplantation einer Spenderleber auf zwei Empfänger (Splitting-Transplantation)-Eine neue Methode in der Weiterentwicklung der Lebersegmenttransplantation. Langenbecks Arch Chir 373:127Google Scholar
  27. 27.
    Pichlmayr R, Grosse H, Hauss J, Gubernatis G, Lamesch P, Bretschneider HJ (1990) Technique and preliminary results of extracorporeal liver surgery (bench procedure) and of surgery on the in-situ perfused liver. Br J Surg 77:21Google Scholar
  28. 28.
    Ringe B, Pichlmayr R (1989) Liver transplantation for malignant tumours. Baillieres Clin Gastroenterol 3:787Google Scholar
  29. 29.
    Ringe B, Wittekind C, Bechstein WO, Bunzendahl H, Pichlmayr R (1989) The role of liver transplantation in hepatobiliary malignancy. A retrospective analysis with particular regard to tumor stage and recurrence. Ann Surg 209:88Google Scholar
  30. 30.
    Ringe B, Pichlmayr R, Wittekind C, Tusch G (1991) Surgical treatment of hepatocellular carcinoma: experience with liver resection and transplantation in 198 patients. World J Surg 15:270Google Scholar
  31. 31.
    Sitzmann JV, Order SE, Klein JC, et al (1987) Conversion by new treatment modalities of nonresectable to resectable hepatocellular cancer. J Clin Oncol 5:1566Google Scholar
  32. 32.
    Starzl TE, Groth GC, Brettschneider L, Moon JJ, Fulginiti VA, Cotton EK, Porter KA (1968) Extended survival in 3 cases of orthotopic homotransplantation of the human liver. Surgery 63:549Google Scholar
  33. 33.
    Starzl TE, Iwatsuki S, Shaw BW, Nalesnik MA, Farhi DC, Van Thiel DH (1986) Treatment of fibrolamellar hepatoma with partial or total hepatectomy and transplantation of the liver. Surg Gynecol Obstet 162:145Google Scholar
  34. 34.
    Starzl TE, Todo S, Tzakis A, Podesta L, Mieles L, Demetris A, Teperman L, Selby R, Stevenson W, Stieber A, Gordon R, Iwatsuki S (1989) Abdominal organ cluster transplantation for upper abdominal malignancies. Ann Surg 210:374Google Scholar
  35. 35.
    Stone MJ, Klintmalm G, Polter D, Husberg B, Egorin MJ (1989) Neoadjuvant chemotherapy and orthotopic liver transplantation for hepatocellular carcinoma. Transplantation 48:2Google Scholar
  36. 36.
    Tang ZY, Yu YQ, Zhou XD, Ma ZC, Yang R, Lu JZ, Lin ZY, Yang BH (1989) Surgery for small hepatocellular carcinoma—analysis of 144 cases. Cancer 64:536Google Scholar
  37. 37.
    Wood WJ, Rawlings M, Evans H, Lim CNH (1988) Hepatocellular carcinoma: importance of histologic classification as a prognostic factor. Am J Surg 155:663Google Scholar
  38. 38.
    Yokoyama I, Todo S, Iwatsuki S, Starzl TE (1990) Liver transplantation in the treatment of primary liver cancer. Hepatogastroenterology 37:188Google Scholar

Copyright information

© Springer-Verlag 1992

Authors and Affiliations

  • Rudolf Pichlmayr
    • 1
  • Arved Weimann
    • 1
  • Gustav Steinhoff
    • 1
  • Burckhardt Ringe
    • 1
  1. 1.Klinik für Abdominal- and TransplantationschirurgieMedizinische Hochschule HannoverHannover 61Germany

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