ABSTRACT
The treatment of liver cancer by transplantation has evolved into a process of selecting
early stage tumors that have a high likelihood of cure. Carefully selected cirrhotic
patients with early hepatocellular cancer (≤ 5 cm. diameter and single; ≤ 3 cm. diameter
if multiple and 3 or fewer lesions; no vascular invasion) have 5-year actuarial survival
rates of approximately 75% after transplantation. Preoperative imaging should be as
extensive as necessary to accurately define the characteristics of tumor size, location,
and number and exclude signs of extrahepatic involvement. Adjuvant and neoadjuvant
chemotherapy became part of treatment protocols in many centers at the same time that
more stringent criteria for transplant candidacy were applied to patients with cancer,
making it difficult to attribute improved results to the chemotherapy. Nevertheless,
neoadjuvant chemoembolization for hepatocellular cancer is logical for patients who
may wait long periods before receiving transplants. The fibrolamellar variant of hepatoma
is a less aggressive tumor and patients can do well after transplantation, but late
recurrences are common. Hepatoblastoma in children can respond very favorably to chemotherapy
combined with transplantation.
Cholangiocarcinoma remains a dreadful malignancy. The rare cases of insitu cholangiocarcioma
in patients who receive transplants for sclerosing cholangitis can be cured, but known
cholangiocarcinoma has an exceedingly high rate of recurrence after transplantation
alone. Recent work combining chemotherapy and radiation with transplantation has not
had dramatic success at improving cure rates. Patients with metastatic neuroendocrine
tumors of the liver can receive good palliation by transplantation, but the majority
of patients eventually develop recurrent cancer.
KEYWORD
transplantation - liver - malignancy
