Liver transplantation for hepatocellular carcinoma

Effective treatment for hepatocellular carcinoma (HCC) includes liver resection and liver transplantation. Partial hepatectomy is the therapy of choice in patients with HCC and non-cirrhotic liver. Selection strategies for liver transplantation have evolved based on the size and number of tumors, which are surrogates for vascular invasion. For most cirrhotic patients who fulfill the Milan criteria (1 nodule <5 cm in diameter or 2-3 nodules, all <3 cm, without macroscopic vascular invasion), liver transplantation is the ultimate treatment option. These criteria provide excellent survival rates of over 70% at 5 years with a recurrence rate of approximately 10%. Liver transplantation restores liver function and ensures the removal of all hepatic foci of tumor and the tissue with a high oncogenic potential for early tumor recurrence. Patients who meet the above criteria should be transplanted within 6 months. Because of the present lack of available organs, living-donor liver transplantation is an alternative for avoiding the long pretrans-plantation waiting time. Locoregional ablating techniques, such as percutaneous ethanol injections and radiofrequency or chemoembolization are used to downstage or to control local tumor growth, to ensure that patients continue to fulfill the Milan criteria for transplantation..n conclusion, liver transplantation should be regarded as the treatment of choice for selected patients with HCC who are not candidates for surgical resection and in whom malignancy is confined to the liver.