Liver Transplantation for Liver Cancer

Abstract

Since its pioneer days, liver transplantation for malignant liver tumors has decreased worldwide, the present percentage within Europe being roughly 15%. There are mainly two reasons for this decrease: First, liver transplantation has matured to an officially recognized therapy for a wide variety of benign endstage liver diseases, favoring patients with these indications in the competition for the sparse donor organs. Secondly, the overall results in tumor patients remained discouraging with unacceptably high, inevitably lethal tumor recurrence rates. In this article, a review of the literature is presented along with our own restrictive concept based mainly on the encouraging Pittsburgh experience with small ( < 5cm largest diameter), solitary hepatocellular carcinomas (HCC). Eight (=7%) of our first 114 patients were transplanted for unresectable liver cancers, six of them are presently without tumor recurrence (three to 23 months observation time). One patient died from tumor recurrence and one from tumor unrelated complications. In addition, four patients were found to have incidental carcinomas: Three HCC, all alive and without tumor and one cholangiocarcinoma presenting with peritoneal carcinomatosis five months postoperatively. Cholangiocarcinomas, metastatic liver disease (except neuroendocrine tumors), and sarcomas as well as extrahepatic tumor spread are excluded from transplantation at our institution. The importance, technique and timing of staging laparotomy is emphasized.