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Review
. 2008 Apr;15(4):1001-7.
doi: 10.1245/s10434-007-9559-5. Epub 2008 Jan 31.

Liver transplantation for hepatocellular carcinoma

Vincenzo Mazzaferro  1 , Yun Shin Chun, Ronnie T P Poon, Myron E Schwartz, Francis Y Yao, J Wallis Marsh, Sherrie Bhoori, Sung-Gyu Lee
Affiliations
Review

Liver transplantation for hepatocellular carcinoma

Vincenzo Mazzaferro et al. Ann Surg Oncol. 2008 Apr.

Abstract

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.

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Figures

FIG. 1.
FIG. 1.
HCC forecast chart showing probability of 5-year survival based on tumor size and number in explanted liver.
See this image and copyright information in PMC

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