Indication and Outcome of Liver Transplantation In Patients with Hepatocellular Carcinoma

Kyung-Suk Suy; Nam-Joon Yi

doi:10.5124/jkma.2008.51.8.708

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Suy and Yi: Indication and Outcome of Liver Transplantation In Patients with Hepatocellular Carcinoma

Focused Issue of This Month

Organ Transplantation in Korea: Where do we stand?

Journal of the Korean Medical Association

Journal of the Korean Medical Association 2008; 51(8): 708-716.

Published online: 31 August 2008

DOI: https://doi.org/10.5124/jkma.2008.51.8.708

Indication and Outcome of Liver Transplantation In Patients with Hepatocellular Carcinoma

Kyung-Suk Suy, MD, Nam-Joon Yi, MD

Department of Surgery, Seoul National University College of Medicine, Korea. kssuh@plaza.snu.ac.kr

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 ≤ 5cm in diameter, or 3 nodules ≤ 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.

Keywords: Hepatocellular carcinoma, Liver transplantation, Milan criteria, Transarterial chemoembolization, Living donor liver transplantation

Figures and Tables

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.

Figure 2

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

Figure 3

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

Figure 4

Treatment strategy of hepatocelluar carcinoma concerning liver transplantation.

Table 1

Anti-tumor effect, hepatic function and viral clearance in treatment modalities for hepatocellular carcinoma (2)

^*The status of viral replication may be even aggravated.

PEI; percutaneous ethanol injection, RFA; radiofrequency ablation therapy, TACE; transarterial chemoembolisation

Table 2

Outcome of liver transplantation in small hepatocellular carcinoma

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