Indication and outcome of liver transplantation in patients with Hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is the most common malignancy of the liver and most commonly associated with hepatitis B infection in Korea-Since HCC arises in cirrhotic livers and is often multicentric, liver transplantation (LT) seems to be a rational and effective approach. Furthermore hepatitis B can be eradicated after LT in more than 90% patients. Current selection criteria of LT for HCC are Milan criteria: single nodule < 5cm in diameter, or 3 nodules <= 3cm each, without major vessel invasion, without extrahepatic metastasis. Patients within Milan criteria showed 75% 5 yeaer survival rate after LT, which was comparable to that of a transplant candidate without HCC. Expanding selection criteria result in more patients with HCC being cured at the expense of a higher incidence of recurrence. Because some, but not all patients with unresectable HCC more than 5cm in diameter have significant vascular invasion and high recurrence rate, this highlights the need to incorporate molecular/biologic information. Pretransplant transarterial chemoembolization and salvage transplantation had a role for down stage or biologic selection of HCC. However, these methods had many controversies about their indication and safety, lindication of LT for HCC patients is similar in living donor LT. In Korea, living donor LT is more popular in LT for HCC and outcome is comparable to that in deceased donor liver transplantation. In the future, with better understanding of tumor biology, a more and better group of patients with HCC can be selected for LT.