Liver transplantation for hepatocellular carcinoma.
Because hepatocellular carcinoma (HCC) arises in cirrhotic livers and is often multifocal, transplantation seems to be a rational approach. Early results were poor, but current restrictive selection criteria can yield excellent results. Patients with 1 HCC nodule </=5 cm in diameter, or 2-3 nodules </=3cm, receive United Network Organ Sharing priority; nevertheless, dropout from the waiting list is common. Predictors of dropout include multiple tumors and tumors with a diameter >3 cm. Nonsurgical methods are commonly used to prevent tumor progression and thus prevent dropout. Expanding selection criteria results in more patients with HCC being cured at the expense of a higher incidence of recurrence. Molecular/biologic information is beginning to be incorporated into current staging systems in order to better predict HCC recurrence. In considering liver transplantation, the impact of the underlying liver disease is an important consideration; recurrent hepatitis C after transplant lowers patient survival independent of tumor recurrence.
Schwartz
Myron
M
Department of Adult Liver Transplantation and Hepatobiliary Surgery, The Mount Sinai School of Medicine, 1 Gustave Levy Pl, Box 1104, New York, New York 10029, USA. Myron.Schwartz@mssm.edu
D006528:Carcinoma, Hepatocellular / Q000628:therapy*; D018450:Disease Progression; D006526:Hepatitis C / Q000150:complications; D006801:Humans; D008113:Liver Neoplasms / Q000628:therapy*; D016031:Liver Transplantation; D010352:Patient Dropouts; D018579:Patient Selection; D011379:Prognosis; D012307:Risk Factors; D014850:Waiting Lists