Liver transplantation for hepatocellular carcinoma.
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.
Mazzaferro
Vincenzo
V
Department of Surgery, National Cancer Institute, Milan, Italy.
Chun
Yun Shin
YS
Poon
Ronnie T P
RT
Schwartz
Myron E
ME
Yao
Francis Y
FY
Marsh
J Wallis
JW
Bhoori
Sherrie
S
Lee
Sung-Gyu
SG
D006528:Carcinoma, Hepatocellular / Q000235:genetics / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008113:Liver Neoplasms / Q000235:genetics / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation; D019520:Living Donors; D018579:Patient Selection; D011379:Prognosis; D016896:Treatment Outcome