Is there a place for liver grafting for malignancy?

Abstract

In 94 patients liver transplantations for malignant tumors of the liver have been performed in this institution from 1972 to 1987. The long-term overall results in hepatic transplantation for irresectable tumors are disappointing in spite of good short-term palliation in most of the patients. Tumor recurrence is the rule. But individual long-living patients demonstrate the potentials of this treatment. Thus the crucial question will be a proper selection of patients. The relative suitability (in descending order of favorableness) of the kinds of tumors may range from HCC without cirrhosis, to central bile duct tumors, to HCC in cirrhosis, to CCC, and finally to secondaries. But this range can only give some probability for the success rate. More important is the tumor stage. Survival in lymph node-positive stages is by far worse than in lymph node-negative stages. The 6-month, 1-year, and 2-year actuarial survival data in our experience for lymph node-negative (lymph node-positive) HCC without cirrhosis are 83%, 75%, 75% (33%, 11%, 11%); in bile duct carcinomas in lymph node-negative stages (lymph node-positive) they are 6 months, 100% (40%); 1 year, 100% (13%); and 2 years, 83% (0%). Hepatic transplantation for selected tumor patients furthermore seems justified and is essential for a detailed analysis of the chance of different tumor types for success with this method of treatment.