Lay Summary: Some people with liver cancer can be cured by liver transplantation.
Among the curative therapies for HCC, LT has gained wider acceptance as improvements in crude survival and recurrence-free survival have been demonstrated in selected cases with curative potential. LT has the advantage of resecting the whole liver, including the HCC, and potentially removing undiagnosed synchronous HCC, daughter HCC, and hepatic micro-invasion. Moreover, LT treats cirrhosis and therefore protects the patient against future complications of cirrhosis and development of a second HCC. The main drawbacks of LT are the high incidence of posttransplant recurrence, which is enhanced by immunosuppressive agents, and the shortage of liver grafts, which leads to long waiting times on the LT list. The doubling time of HCC is approximately 6 months; thus, a significant number of patients become nontransplantable during the interval between evaluation and acceptance for LT and availability of a graft, leading to a significant drop-out rate (due to death) that is variable across centers and responsible for variable management strategies across centers. This factor should be included in all studies comparing results of LT to liver resection for HCC (intent-to-treat analysis).
To date, no randomized study has been done to compare results of resection vs LT for HCC and, therefore, no definite conclusion about which treatment offers the best outcome can be made. Such a study is unlikely, however, because recent, good retrospective papers have reported better results for LT compared with resection in selected cases. There are no guidelines. The consensus of the literature is that in selected cases liver transplantation is medically appropriate.
Bigourdan JM, Jaeck D, Meyer N, et al. Small hepatocellular carcinoma in Child A cirrhotic patients: hepatic resection versus transplantation. Liver Transpl. 2003;9:513-520.
Prof Pierre-Alain Clavien MD at al ,Recommendations for liver transplantation for hepatocellular carcinoma: an international consensus conference report The Lancet Oncology, Volume 13, Issue 1, Pages e11 – e22, January 2012
Peipei Song et al, The management of hepatocellular carcinoma around the world: a comparison of guidelines from 2001 to 2011 ,Article first published online: 20 MAR 2012