Current role of liver transplantation for hepatocellular carcinoma. Where are we?

Abstract

Liver transplantation (LT) is the only treatment of choice that offers cure for patients with hepatocellular carcinoma (HCC) and underlying liver cirrhosis. The success of LT for HCC depends very much on the patient selection, in which biological aggressiveness of tumor plays an important role. Deceased donor liver transplantation (DDLT) and living donor liver transplantation (LDLT) are the two main approaches of LT worldwide. In DDLT, strict patient selection for LT should be adopted as the cadaveric liver graft is precious to both cirrhotic patients without HCC and those with HCC. Over the years, the Milan criteria is a reliable and easily applicable way to select out good–risk patients with early HCC for LT. To maximize the benefit of LT, extended criteria using serum tumor marker assay, positron emission tomography or tumor biopsy and the down–staging protocol can justify the application of LT for HCC patients without compromising survival. LDLT is an alternative way to pursue LT for HCC and is the main LT approach in Asia–Pacific region where cadaveric liver graft is scarce. High degree of flexibility in patient selection is allowed in LDLT, but the results might be compromised by the“fast–track”surgery and the potential small–for–size syndrome. Nonetheless, favorable results can be achieved in selected good–risk patients. Salvage transplantation following curative hepatectomy is another debatable approach. On the whole, the role of LT for HCC is evolving and selected good–risk patients with HCC can be benefited with good long–term survival outcome.