Hepatocellular Carcinoma and Liver Transplantation

Kim, Dong Goo

Abstract

In a study by Mazzaferro et al, the patient with Milan criteria had excellent survival and disease free survival rate of 85 % and 92% respectively, at 4 years after liver transplantation and this criteria have been widely used as the guideline for the selection of candidates for liver transplantation in many transplantation center. Milan criteria will exclude a large portion of patients from liver transplantation and some studies suggested an expansion of the selection criteria without affecting outcome. The University of California, San Francisco (UCSF) group proposed an expansion of the selection criteria according to tumors characteristics, while preserving excellent survival after liver transplantation. The limitation of clinical staging system based soley on the results of the pretransplantation imaging technique, inaccurate and understaging identified as meeting standard criteria. when applied to pretransplantation evaluation, the expansion criteria are associated with lower survival rate and disease free survival rate. In contrast to long waiting time and high dropout rate in cadaver transplantation, living donor liver transplantation (LDLT) appear the alternative method and LDLT is chosen by the balance of the risk and benefit for donor and recipients. The most centers demonstrated favorable results in patients chosen by extended selection criteria. Most centers in Korea had a concensus on exclusion of extrahepatic metastasis and major vascular invasion in principle. The broadest criteria such as exclusion of major vessel invasion which expanded the patients by about 20%, result in the 3 years of 86.8%, not significant different from Milan criteria. With the aim of reducing dropout rates on the waiting list, locoregional therapy can be offered to patient at risk for tumor progression. While favorable results in terms of local tumor necrosis and improved survival rate were observed in some centers, others made poor efficacy. Whether liver transplantation or liver resection is the optional initial treatment for early tumor in compansated liver cirrhosis depends on the survival rate. The similar result in both treatment modality and the shortage of cadaver donor liver graft, Most center recommand the liver resection as the first line therapy. Resection first and salvage transplantation for recurrent tumor or liver failure has been shown to be a feasible strategy in the most patients.