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Liver transplantation for hepatocellular carcinoma

Authors
George Tsoulfas, MD
Steven A Curley, MD, FACS
Eddie K Abdalla, MD
Carlton C Barnett, Jr, MD
Martin Hertl, MD
Section Editors
Kenneth K Tanabe, MD
Robert S Brown, Jr, MD, MPH
Deputy Editor
Diane MF Savarese, MD

INTRODUCTION

Hepatocellular carcinoma (HCC) is an aggressive tumor that often occurs in the setting of chronic liver disease and cirrhosis. (See "Epidemiology and etiologic associations of hepatocellular carcinoma".)

The only potentially curative treatment options are resection and liver transplantation. Among patients who are not candidates for liver resection, some who have cirrhosis and HCC are candidates for potentially curative liver transplantation. Unfortunately, the majority of patients are not eligible for either resection or transplantation because of tumor extent, underlying liver dysfunction, and lack of donor organs. This has led to the development of many other treatments and combinations for treatment of HCC including local tumor ablation. (See "Surgical management of potentially resectable hepatocellular carcinoma".)

Treatment algorithms for HCC — There are several therapeutic options for treatment of localized HCC. A general approach to treatment is shown in the figure (algorithm 1). An alternative treatment algorithm has been published by the Barcelona group (algorithm 2) [1].

However, attempts to generate algorithmic approaches to the treatment of HCC are difficult since new treatments and indications for various treatments are evolving rapidly. Furthermore, therapeutic approaches tend to vary based upon the available expertise. These issues and a general approach to treatment of HCC are discussed in detail elsewhere. (See "Overview of treatment approaches for hepatocellular carcinoma".)

EVOLUTION OF TRANSPLANTATION FOR HCC

Liver transplantation for treatment of hepatocellular carcinoma (HCC) is attractive because resection of the malignant tumor can be achieved while also replacing the cirrhotic liver that remains at risk for the development of new lesions. However, early experience with transplantation for patients with unresectable local HCC was disappointing. Unacceptable 90-day mortality rates, tumor recurrence in up to 80 percent of patients, and long-term survival rates that were well below that of patients transplanted for nonmalignant disease all reflected the advanced nature of the disease [2,3].

                           

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Literature review current through: Nov 2016. | This topic last updated: Thu Aug 25 00:00:00 GMT 2016.
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