[Liver transplantation for hepatocellular carcinoma and for patients with pre-existing cancers].
Hepatocellular carcinoma (HCC) is currently the leading indication for liver transplantation in France, accounting for 25% of all cases. Transplantation is appropriate, nonetheless, only for patients whose HCC has a low risk of posttransplant recurrence and is limited in size and number, meeting the Milan criteria (1 single nodule of a maximum diameter of 5 cm or 3 lesions of a maximum diameter of 3 cm), or slightly exceeds these criteria without vascular invasion visible on preoperative imaging. Results for this indication are very satisfactory, and 5-year survival ranges from 60 to 80%, according to tumor stage. Small HCCs (<2 cm) are usually treated conservatively. Transplantation is proposed in cases of a contraindication to resection or radiofrequency ablation or of recurrence after local treatment. A history of an extrahepatic tumor is found in approximately 5% of candidates for liver transplantation. This history is not necessarily a contraindication to transplantation. They may be considered eligible for a graft after discussion in a multidisciplinary meeting, if the extrahepatic tumor was treated curatively and if their 5-year tumor-related life expectancy is greater than 50-60%.
Hurtova
Monika
M
Service d'hépato-gastro-entérologie, Hôpital Henri Mondor, AP-HP, Université Paris XII Val-de-Marne, Créteil, France.
Decaens
Thomas
T
Laurent
Alexis
A
Cherqui
Daniel
D
Duvoux
Christophe
C
D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery*; D000075202:Contraindications; D006801:Humans; D016867:Immunocompromised Host / Q000276:immunology; D016030:Kidney Transplantation / Q000276:immunology; D008017:Life Expectancy; D008103:Liver Cirrhosis / Q000601:surgery; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation / Q000401:mortality / Q000592:standards*; D009364:Neoplasm Recurrence, Local / Q000276:immunology / Q000517:prevention & control / Q000628:therapy; D009367:Neoplasm Staging; D009378:Neoplasms, Multiple Primary / Q000276:immunology; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D011230:Precancerous Conditions / Q000601:surgery; D047368:Tumor Burden