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Liver Transplantation for Hepatocellular Carcinoma

¹ Department of Surgery, National Cancer Institute, Milan, Italy
² Department of Surgical Oncology, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
³ Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
⁴ The Recanati/Miller Transplantation Institute and Department of Surgery, The Mount Sinai Hospital, New York, New York, USA
⁵ Department of Medicine, Division of Gastroenterology, University of California, San Francisco, San Francisco, California
⁶ Department of Surgery, Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
⁷ Department of Surgery, Hepato-Biliary Surgery and Liver Transplantation, Asan Medical Center, Ulsan University, Seoul, Korea

Correspondence: Address correspondence and reprint requests to: Sung-Gyu Lee, MD, PhD; E-mail: sglee2{at}amc.seoul.kr

Background: Orthotopic liver transplantation (OLT) is the best available option for early hepatocellular carcinoma (HCC), although its application is limited by stringent selection criteria, costs, and deceased donor graft shortage, particularly in Asia, where living donor liver transplant (LDLT) has been developed.

Methods: This article reviews the present standards for patient selection represented by size-and-number criteria with particular references to Milan Criteria and novel prediction models based on results achieved in patients exceeding those limits, with consideration of the expanded indication represented by the UCSF Criteria.

Results: The expected outcomes after deceased donor liver transplant (DDLT) or LDLT are favorable if predetermined selection criteria are applied. However, selection bias, difference in waiting time, and ischemia-regeneration injuries of the graft among DDLT vs LDLT may influence long-term results. In the article, the differences between East and West in first-line treatments for HCC (resection vs transplantation), indications, and ethics for the donor, are summarized as well as possible novel predictors of tumor biology (especially DNA mutation and fractional allelic loss, FAI) to be considered for better outcome prediction.

Conclusions: Liver transplantation remains the most promising product of modern surgery and represents a cornerstone in the management of patients with HCC.

Key Words: Hepatocellular • Hepatoma • Transplantation