Liver Transplantation for Hepatocellular Carcinoma

Background: The treatment of hepatocellular carcinoma (HCC) is challenging, but transplantation of the liver has emerged as one of the options in the therapeutic armamentarium against this disease. Methods: This article reviews the changing criteria for patient eligibility for liver transplantation for HCC and presents an initial evaluation of institutional treatment outcomes for this treatment modality. A method for evaluating prognosis is also described. Results: Patients are considered for liver transplantation if they meet the Milan criteria for eligibility or a UCSF-attributed expansion of these criteria that includes the rule of 7, whereby the sum of the size of the largest nodule plus the total number of nodules cannot exceed 7. Preliminary institutional experience suggests a tumor recurrence rate of 11% in 91 patients with HCC who received liver transplants between 1996 and 2008. Conclusions: Liver transplantation offers an opportunity for long-term survival in patients with HCC and chronic cirrhosis whose tumor cannot be resected. Criteria for patient selection for this modality of treatment continue to be upgraded and refined.