J Korean Med Assoc.  2008 Aug;51(8):708-716. 10.5124/jkma.2008.51.8.708.

Indication and Outcome of Liver Transplantation In Patients with Hepatocellular Carcinoma

• Suy KS
• Yi NJ

• KMID: 2185928
• DOI: http://doi.org/10.5124/jkma.2008.51.8.708

Abstract

Hepatocellular carcinoma (HCC) is the most common malignancy of the liver and most commonly associated with hepatitis B infection in Korea. Since HCC arises in cirrhotic livers and is often multicentric, liver transplantation (LT) seems to be a rational and effective approach. Furthermore hepatitis B can be eradicated after LT in more than 90% patients. Current selection criteria of LT for HCC are Milan criteria; single nodule < or = 5cm in diameter, or 3 nodules < or = 3cm each, without major vessel invasion, without extrahepatic metastasis. Patients within Milan criteria showed 75% 5-yeaer survival rate after LT, which was comparable to that of a transplant candidate without HCC. Expanding selection criteria result in more patients with HCC being cured at the expense of a higher incidence of recurrence. Because some, but not all patients with unresectable HCC more than 5cm in diameter have significant vascular invasion and high recurrence rate, this highlights the need to incorporate molecular/biologic information. Pretransplant transarterial chemoembolization and salvage transplantation had a role for down stage or biologic selection of HCC. However, these methods had many controversies about their indication and safety. Iindication of LT for HCC patients is similar in living donor LT. In Korea, living donor LT is more popular in LT for HCC and outcome is comparable to that in deceased donor liver transplantation. In the future, with better understanding of tumor biology, a more and better group of patients with HCC can be selected for LT.

Keyword

Hepatocellular carcinoma; Liver transplantation; Milan criteria; Transarterial chemoembolization; Living donor liver transplantation

MeSH Terms

Biology
Carcinoma, Hepatocellular
Glycosaminoglycans
Hepatitis B
Humans
Incidence
Korea
Liver
Liver Transplantation
Living Donors
Neoplasm Metastasis
Patient Selection
Recurrence
Survival Rate
Tissue Donors
Transplants
Glycosaminoglycans

Figure

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  Figure 1 Cumulative survival curves of the patients with hepatocelluar carcinoma (9). A significant difference of the cumulative survival curves occurred according to the Milan criteria.

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  Figure 2 Clinical outcome of the patients who underwent pre-transplant transarterial chemoembolization meeting (n=34) or exceeding (n=62) Milan criteria (33).

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  Figure 3 Barcelona-Clinic Liver Cancer staging classification and treatment schedule (8).

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  Figure 4 Treatment strategy of hepatocelluar carcinoma concerning liver transplantation.

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