Liver transplantation for hepatocellular carcinoma in the world: the Taiwan experience

Liver transplantation (LT) has been regarded as "potentially curative'' in a cirrhotic patient with hepatocellular carcinoma (HCC) because it removes the cancer and eradicates the cirrhosis. In Taiwan, HCC ranks first among the leading causes of cancer mortality in males and 4th in females. The most common causes are chronic hepatitis B virus-related cirrhosis, hepatitis C virus-related cirrhosis, and combined hepatitis B and C virus-related cirrhosis. The aggregate lifetime cost of hepatitis and HCC constitutes a significant burden on the Taiwanese health-care system. The reported overall (living-donor LT and deceased donor LT) 1- and 3-year survival rates for HCC after LT in Taiwan ranged from 86 to 98% and 61 to 96%, respectively. Microscopic vascular invasion did not influence the outcome of patients, but high alpha-fetoprotein levels >200 ng/ml may be a risk factor for HCC recurrence after transplant.