Korean J Gastroenterol.  2010 Jun;55(6):350-360. 10.4166/kjg.2010.55.6.350.

Liver Transplantation in Patients with Hepatocellular Carcinoma

Affiliations
  • 1Department of Surgery, Division of Liver Transplantation and Hepatobiliary Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. sglee2@amc.seoul.kr

Abstract

Hepatocellular carcinoma (HCC) is the third most common malignancy, with a new incidence of more than 11,000 cases per year and the second most common cause of malignancy-related death in Korean males. In Korea, more than 80% of all HCCs have developed from hepatitis B virus (HBV)-related cirrhotic livers. Liver transplantation (LT) is the only treatment that offers a chance of cure for HCC and the underlying liver cirrhosis simultaneously, but the availability of liver grafts and the aggressiveness of tumor recurrence are critical limiting factors of LT for HCC patients. The serious shortage of deceased-donors on strong demand for LT leads to the development of living-donor LT (LDLT) as a practical alternative replacing deceased-donor LT. Considering that HCC recurrence is the most common cause of posttransplant patient death, recipient candidates should be prudently selected through objectively established criteria. Uniquely, some Asian major LDLT centers challenged the Milan criteria, accepting a much higher number of HCC nodules instead of tumor size expansion. The eligibility criteria of LDLT for HCC are likely to be expanded more than before, but it still requires further qualified risk-benefit analyses. The development of new effective treatment modalities for HCC recurrence will reasonably expand the selection criteria further wide without the expense of recurrence rate. This article is mainly focused on the role of LT for HCC and discussed on the validity of currently available indication criteria.

Keyword

Hepatocellular carcinoma; Liver transplantation; Indication criteria

MeSH Terms

Biological Markers/analysis
Carcinoma, Hepatocellular/*surgery
Female
Humans
Liver Neoplasms/*surgery
*Liver Transplantation
Male
Neoplasm Staging
Recurrence
Severity of Illness Index

Figure

  • Fig. 1. Liver resection and transplantation for hepatocellular carcinoma at Asan Medical Center from June 1989 to December 2008.

  • Fig. 2. Annual changes in the proportion of hepatocellular carcinoma patients in adult living-donor liver transplantation at Asan Medical Center.

  • Fig. 3. Comparison of the hepatocellular carcinoma (HCC) recurrence curves of 206 patients who underwent living-donor liver transplantation from February 1997 to December 2004 at Asan Medical Center based on explant pathology. (A) HCC recurrence curves of the patients beyond the Milan criteria but within UCSF criteria showed 1-year, 3-year, and 5-year recurrence rates of 0%, 20.0%, and 20.0%, respectively. There was no statistically significant difference in recurrence rates between the patient group beyond the Milan criteria but within the UCSF criteria and the patient group within the Milan criteria (p=0.626). (B) HCC recurrence curves of the patients beyond the Milan criteria but within the Asan criteria showed 1-year, 3-year, and 5-year recurrence rates of 0%, 9.1%, and 9.1%, respectively. There was no statistically significant recurrence difference between the patient group beyond the Milan criteria but within the Asan criteria and that within the Milan criteria (p=0.554).6

  • Fig. 4. Comparison of the patient survival curves of 206 patients who underwent living-donor liver transplantation from February 1997 to December 2004 at Asan Medical Center based on explant pathology. (A) Patient survival curves of the patients beyond the Milan criteria but within UCSF criteria showed 1-year, 3-year, and 5-year survival rates of 100%, 90.0%, and 78.8%, respectively. There was no statistically significant difference in survival rates between the patient group beyond the Milan criteria but within the UCSF criteria and the patient group within the Milan criteria (p=0.923). (B) Patient survival curves of patients beyond the Milan criteria but within the Asan criteria showed 1-year, 3-year, and 5-year recurrence rates of 100%, 88.9%, and 80.0%, respectively. There was no statistically significant survival difference between the patient group beyond the Milan criteria but within the Asan criteria and that within the Milan criteria 6

  • Fig. 5. Recurrence of hepatocellular carcinoma in recipients having positive positron emission tomography (PET) scans. LDLT, living-donor liver transplantation.


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