[Liver transplantation for cancer].
Hepatocellular carcinoma (HCC) is a major indication of liver transplantation (LT). For HCC accessible to conventional therapies, resection or radiofrequency ablation, 5-year survival is similar after LT or conventional therapy, although recurrence-free survival is better after LT. For the other cases, the Milan criteria (single nodule < 5 cm or no more than 3 nodules, less than 3 cm), limiting the risk of recurrence to 15%, are universally used. The "liver score", established by the french Agency of biomedicine, gives a national rank on the LT waiting list. It is a sum of components, including one based on the MELD score, evaluating the severity of cirrhosis (maximum 1000 points) and an HCC component (maximum 200 points). The liver score will be regularly revisited. A treatment is often necessary during the waiting period, if the waiting time may be longer than 6 months. Hepatoblastoma, cholangiocarcinoma and neuroendocrine metastases are marginal indications of LT. LT is possible in patients with a pasthistory of extrahepatic cancer. The risk of recurrence (or transformation of hemopathies) is lower than 5% at 10 years, probably because of the extensive selection made among these patients.
Calmus
Yvon
Y
Unité de transplantation hépatique, hôpital Cochin, 75679 Paris Cedex 14, France. yvon.calmus@cch.aphp.fr
D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D017115:Catheter Ablation; D005500:Follow-Up Studies; D006801:Humans; D008099:Liver / Q000473:pathology; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D018579:Patient Selection; D012189:Retrospective Studies; D012306:Risk; D016019:Survival Analysis; D013997:Time Factors