The Role of Liver Transplantation in the Treatment of Primary Liver Tumors

Summary

From a worldwide perspective, hepatocellular carcinoma (HCC) and cholangiocarcinoma account for 84% and 13% of all primary liver tumors, respectively. Liver transplantation has resulted in poor results when used for non-cirrhotic patients suffering from either HCC or cholangiocarcinoma. The only exception is fibrolamellar carcinoma; whether this is an indication for liver transplantation is still under consideration. The tumor indication with the most favorable survival rate is early HCC in cirrhosis. Vascular invasion is the most serious risk factor, but its detection is still impossible prior to the histopathological examination of a specimen. Therefore, surrogate markers are required. Stringent selection criteria relating to size and number of tumor nodules have been identified and must be adhered to in order to avoid recurrence. Recurrence is especially harmful in the transplant population because the immunosuppressive treatment appears to reduce the time taken for the tumor to double in volume.

Another major problem for liver transplantation as a therapy for malignancy is an increasing shortage of donor grafts. This situation may be changed by a wider introduction of living-donor liver transplantation among adults. To date, there are no reports on the outcome after adult living-donor liver transplantations for extended, or even critical, indications of HCC.