title: Liver transplantation for hepatocellular carcinoma in cirrhosis within the Eurotransplant area: an additional option with "livers that nobody wants".
abstract: BACKGROUND
  Liver transplantation is recognized as the treatment of choice for small hepatocellular carcinomas (HCC) in patients with end-stage liver failure. However, because of limited organ availability, not all those who qualify can benefit from it.
  
  
  METHODS
  Over a 3-year period, we accepted and subsequently transplanted 10 deceased donor liver allografts allocated through Eurotransplant. These organs had been officially offered to and rejected by other transplant centers a total of 40 times due to medical or logistical reasons prior to our acceptance. They were implanted into patients in the waiting list with HCC and cirrhosis. Recipients without HCC transplanted with such "undesirable" grafts were not included in this study.
  
  
  RESULTS
  Two patients had initial poor graft function but subsequently recovered. There was one arterial complication requiring reintervention. Median intensive care unit and hospital stays were 6 and 28 days respectively. One patient developed renal insufficiency, but recovered after 3 months. One patient developed HCC recurrence in the allograft and underwent a successful atypical liver resection 23 months after transplantation. All patients are currently alive, with follow-up periods ranging from 5 to 36 months.
  
  
  CONCLUSIONS
  Liver transplantation with such "livers that nobody wants" constitutes an additional option for patients with HCC and cirrhosis. The risk-benefit ratio in these instances should be evaluated on a case-by-case basis.
authors.affiliation: Department of General Surgery and Transplantation, University Hospital Essen, Essen, Germany.
authors.forename: Georgios C
authors.initials: GC
authors.lastname: Sotiropoulos
authors.forename: Andreas
authors.initials: A
authors.lastname: Paul
authors.forename: Ernesto
authors.initials: E
authors.lastname: Molmenti
authors.forename: Hauke
authors.initials: H
authors.lastname: Lang
authors.forename: Andrea
authors.initials: A
authors.lastname: Frilling
authors.forename: Bogdan P
authors.initials: BP
authors.lastname: Napieralski
authors.forename: Silvio
authors.initials: S
authors.lastname: Nadalin
authors.forename: Jürgen
authors.initials: J
authors.lastname: Treckmann
authors.forename: Eirini I
authors.initials: EI
authors.lastname: Brokalaki
authors.forename: Till
authors.initials: T
authors.lastname: Gerling
authors.forename: Christoph E
authors.initials: CE
authors.lastname: Broelsch
authors.forename: Massimo
authors.initials: M
authors.lastname: Malagó
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000601:surgery*; D005060:Europe; D005260:Female; D006085:Graft Survival; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000601:surgery*; D008113:Liver Neoplasms / Q000150:complications / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D014019:Tissue Donors / Q000600:supply & distribution; D014184:Transplantation, Homologous; D016896:Treatment Outcome