Current status of liver transplantation for treatment of hepatocellular carcinoma.
Hepatocellular carcinoma accounts for more than 5% of all malignancies with a continuous increase worldwide. The most important risk factor is liver cirrhosis, frequently associated with hepatitis B virus or hepatitis C virus infection. Liver resection is the only treatment that can potentially achieve cure. In carefully selected patients with a tumor smaller than 5 cm the 5-year survival is around 50%. The presence of liver cirrhosis and portal hypertension limits the feasibility of hepatic resection. Child-Pugh A patients without major associated risk factors may be considered as the ideal target group for resection. A significant local disease recurrence rate of more than 70% at 5 years is the main problem of hepatic resection. Orthotopic liver transplantation offers the possibility of removing a potentially multicentric tumor and the underlying end-stage liver disease. Due to pure selection of suitable candidates the initial reports on the efficacy of liver replacement in a cohort of patients with hepatocellular carcinoma were disappointing. Taking the shortness of donor organs and the high posttransplant tumor recurrence rate into account, several groups developed criteria qualifying transplantation. A tumor size of >6 cm and gross intrahepatic portal vein involvement seem to be of significant prognostic importance. Patients with smaller solitary tumors or less than 3 tumors with a total tumor diameter of <8 cm have the same survival after transplantation as those with benign liver disease. Living donor liver transplantation offers a new approach to overcome the organ shortage and to theoretically extend the indication for transplantation in hepatocellular carcinoma.
Frilling
A
A
Department of General Surgery and Transplantation, University Hospital Essen, Germany.
Malago
M
M
Broelsch
C E
CE
D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000628:therapy*; D006509:Hepatitis B / Q000150:complications; D006526:Hepatitis C / Q000150:complications; D006801:Humans; D006975:Hypertension, Portal; D008103:Liver Cirrhosis; D008107:Liver Diseases; D008113:Liver Neoplasms / Q000150:complications / Q000628:therapy*; D016031:Liver Transplantation; D009364:Neoplasm Recurrence, Local; D018579:Patient Selection; D011379:Prognosis; D012307:Risk Factors; D014019:Tissue Donors