Liver Transplantation for Hepatocellular Carcinomas

ABSTRACT

PURPOSE: Currently, the role of liver transplantation in the treatment of hepatocellular carcinomas with cirrhosis is controversial due to the shortage of donors and to the high recurrence rate after transplantation. What remain to be determined are the best treatment protocol and who are likely to have a good outcome after liver transplantation. METHODS: Eight patients (all male, range 30 to 67 years) with a hepatocellular carcinoma underwent liver transplantation between 1993 and 1999 in Catholic University, Medical College. The criteria for exclusion of transplantation were extrahepatic tumor metastasis, positive regional lymph nodes, and tumor thrombus on the main portal trunk. All except one were treated with preoperative arterial chemoembolization alone or combined with chemotherapy or ethanol injection. The follow-up period was from 5 months to 27 months. The pathologic findings, the recurrence, and the survival rate were analyzed. RESULTS: One patient had a tumor, larger than 5 cm in diameter (5.9 cm) and another patient had 6 nodules in number. Vascular invasion was present in 3 patients. Among the 8 patients, postsurgical TNM staging was stage III in 3 patients and stage IVA in 2 patients. During the follow-up, 7 of the 8 patients (87.5%) survived, and the number of disease-free survivals was 6 among the 8 patients (75%). One patient died with recurrent hepatitis C 6 months after transplantation without tumor recurrence. The patient who had the largest tumor in size had recurrent cancer on the abdominal wall at 9 months after transplantation, and subsequent pulmonary recurrences at 15 and 19 months which were treated by resection. CONCLUSION: Hepatocellular carcinoma could be a good indication for liver transplantation in selected patient, but the best protocol remains to be determined, especially in large tumors.