Hepatitis B is endemic in many regions of Asia, including China, Korea and India. This results in a heavy burden of hepatocellular carcinoma (HCC) because hepatitis B virus is a major risk factor in the development of the disease. In addition, the incidence of hepatitis-C-related HCC is on the rise in the United States. HCC patients with poor liver function reserve are not suitable candidates for resection, and liver transplantation (LT) has emerged as the treatment of choice for small unresectable HCCs. To treat more HCC patients with LT, the standard patient selection criteria have been expanded at a number of centers. Careful and well-considered selection of patients is the key to success in LT for HCC. Although tumor size and tumor number are used to predict whether transplantation is likely to be successful, the weighting that should be attached these two parameters has not been determined. In addition to the size and number of lesions, the morphology of HCC is also predictive of its behavior. Well-circumscribed lesions, in general, are less aggressive than those with poorly defined borders. On the waiting list for LT, HCC patients compete with liver failure patients. It is essential that the criteria used for selecting HCC patients for LT should be easily applicable and fair to other transplant candidates. In the face of the scarcity of deceased-donor livers and the inevitable risks for living liver donors, a predictably low rate of recurrence of HCC after LT is mandatory.

Keywords:
Hepatocellular carcinoma, Liver transplantation, Living donor
1.
El-Serag HB: Epidemiology of hepatocellular carcinoma in USA. Hepatology Research 2007;37Suppl 2:S88-94.
2.
Belghiti J, Fuks D: Liver resection and transplantation in hepatocellular carcinoma. Liver Cancer 2012;1:71-82.
3.
Cheah YL, Chow P: Liver transplantation for hepatocellular carcinoma: an appraisal of current controversies. Liver Cancer 2012;1:183-189.
4.
Mazzaferro V, Regalia E, Doci R, Andreola S, Pulvirenti A, Bozzetti F, Montalto F, Ammatuna M, Morabito A, Gennari L: Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med 1996;334:693-699.
5.
Yao FY, Ferrell L, Bass NM, Watson JJ, Bacchetti P, Venook A, Ascher NL, Roberts JP: Liver transplantation for hepatocellular carcinoma: expansion of the tumor size limits does not adversely impact survival. Hepatology 2001;33:1394-1403.
6.
Penn I: Hepatic transplantation for primary and metastatic cancers of the liver. Surgery 1991;110:726-734, discussion 734-735.
7.
Bismuth H, Chiche L, Adam R, Castaing D, Diamond T, Dennison A: Liver resection versus transplantation for hepatocellular carcinoma in cirrhotic patients. Ann Surg 1993;218:145-151.
8.
Chen CL, Concejero AM: Liver transplantation for hepatocellular carcinoma in the world: the Taiwan experience. J Hepatobiliary Pancreat Sci 2010;17:555-558.
9.
Schwartz M: Liver transplantation for hepatocellular carcinoma. Gastroenterology 2004;127:S268-S276.
10.
Pawlik TM, Delman KA, Vauthey JN, Nagorney DM, Ng IO, Ikai I, Yamaoka Y, Belghiti J, Lauwers GY, Poon RT, Abdalla EK: Tumor size predicts vascular invasion and histologic grade: implications for selection of surgical treatment for hepatocellular carcinoma. Liver Transpl 2005;11:1086-1092.
11.
DuBay D, Sandroussi C, Sandhu L, Cleary S, Guba M, Cattral MS, McGilvray I, Ghanekar A, Selzner M, Greig PD, Grant DR: Liver transplantation for advanced hepatocellular carcinoma using poor tumor differentiation on biopsy as an exclusion criterion. Ann Surg 2011;253:166-172.
12.
Pawlik TM, Gleisner AL, Anders RA, Assumpcao L, Maley W, Choti MA: Preoperative assessment of hepatocellular carcinoma tumor grade using needle biopsy: implications for transplant eligibility. Ann Surg 2007;245:435-442.
13.
Okada S, Ishii H, Nose H, Okusaka T, Kyogoku A, Yoshimori M, Sakamoto M, Hirohashi S: Intratumoral DNA heterogeneity of small hepatocellular carcinoma. Cancer 1995;75:444-450.
14.
Washburn K, Edwards E, Harper A, Freeman R: Hepatocellular carcinoma patients are advantaged in the current liver transplant allocation system. Am J Transplant 2010;10:1643-1648.
15.
Sugawara Y, Tamura S, Makuuchi M: Living donor liver transplantation for hepatocellular carcinoma: Tokyo University series. Dig Dis 2007;25:310-312.
16.
Lee SG, Hwang S, Moon DB, Ahn CS, Kim KH, Sung KB, Ko GY, Park KM, Ha TY, Song GW: Expanded indication criteria of living donor liver transplantation for hepatocellular carcinoma at one large-volume center. Liver Transpl 2008;14:935-945.
17.
Ito T, Takada Y, Ueda M, Haga H, Maetani Y, Oike F, Ogawa K, Sakamoto S, Ogura Y, Egawa H, Tanaka K, Uemoto S: Expansion of selection criteria for patients with hepatocellular carcinoma in living donor liver transplantation. Liver Transpl 2007;13:1637-1644.
18.
Taketomi A, Sanefuji K, Soejima Y, Yoshizumi T, Uhciyama H, Ikegami T, Harada N, Yamashita Y, Sugimachi K, Kayashima H, Iguchi T, Maehara Y: Impact of des-gamma-carboxy prothrombin and tumor size on the recurrence of hepatocellular carcinoma after living donor liver transplantation. Transplantation 2009;87:531-537.
19.
Todo S, Furukawa H, Tada M: Extending indication: role of living donor liver transplantation for hepatocellular carcinoma. Liver Transpl 2007;13:S48-54.
20.
Yao FY, Kerlan RK Jr, Hirose R, Davern TJ 3rd, Bass NM, Feng S, Peters M, Terrault N, Freise CE, Ascher NL, Roberts JP: Excellent outcome following down-staging of hepatocellular carcinoma prior to liver transplantation: an intention-to-treat analysis. Hepatology 2008;48:819-827.
21.
Concejero A, Chen CL, Wang CC, Wang SH, Lin CC, Liu YW, Yang CH, Yong CC, Lin TS, Jawan B, Huang TL, Cheng YF, Eng HL: Living donor liver transplantation for hepatocellular carcinoma: a single-center experience in Taiwan. Transplantation 2008;85:398-406.
22.
Bigourdan JM, Jaeck D, Meyer N, Meyer C, Oussoultzoglou E, Bachellier P, Weber JC, Audet M, Doffoel M, Wolf P: Small hepatocellular carcinoma in Child A cirrhotic patients: hepatic resection versus transplantation. Liver Transpl 2003;9:513-520.
23.
Ikegami T, Shimada M, Imura S, Yoshizumi T, Arakawa Y, Tokunaga T, Morine Y, Kanemura H: The timing of liver transplantation after primary hepatectomy for hepatocellular carcinoma: a special reference to recurrence pattern and Milan criteria. Transplantation 2008;86:641-646.
24.
Hwang S, Lee SG, Moon DB, Ahn CS, Kim KH, Lee YJ, Ha TY, Song GW: Salvage living donor liver transplantation after prior liver resection for hepatocellular carcinoma. Liver Transpl 2007;13:741-746.
25.
Hwang S, Moon DB, Lee SG: Liver transplantation and conventional surgery for advanced hepatocellular carcinoma. Transplant International 2010;23:723-727.
26.
Sala M, Fuster J, Llovet JM, Navasa M, Sole M, Varela M, Pons F, Rimola A, Garcia-Valdecasas JC, Bru C, Bruix J: High pathological risk of recurrence after surgical resection for hepatocellular carcinoma: an indication for salvage liver transplantation. Liver Transpl 2004;10:1294-1300.
27.
Chan SC, Fan ST, Chok KS, Cheung TT, Chan AC, Fung JY, Poon RT, Lo CM. Survival advantage of primary liver transplantation for hepatocellular carcinoma within the up-to-7 criteria with microvascular invasion. Hepatol Int 2012;6:646-656.
28.
Fan ST, Mau Lo C, Poon RT, Yeung C, Leung Liu C, Yuen WK, Ming Lam C, Ng KK, Ching Chan S: Continuous improvement of survival outcomes of resection of hepatocellular carcinoma: a 20-year experience. Ann Surg 2011;253:745-758.
29.
Cotler SJ, McNutt R, Patil R, Banaad-Omiotek G, Morrissey M, Abrams R, Cotler S, Jensen DM: Adult living donor liver transplantation: preferences about donation outside the medical community. Liver Transpl 2001;7:335-340.
30.
Tan KC: Liver transplantation for hepatocellular carcinoma: how far can we push the envelope? Singapore Med J 2003;44:309-311.
31.
Lee JW, Paeng JC, Kang KW, Kwon HW, Suh KS, Chung JK, Lee MC, Lee DS: Prediction of tumor recurrence by 18F-FDG PET in liver transplantation for hepatocellular carcinoma. Journal of Nuclear Medicine 2009;50:682-687.
32.
Cheung TT, Chan SC, Ho CL, Chok KS, Chan AC, Sharr WW, Ng KK, Poon RT, Lo CM, Fan ST: Can positron emission tomography with the dual tracers [11C]acetate and [18F]fludeoxyglucose predict microvascular invasion in hepatocellular carcinoma? Liver Transpl 2011;17:1218-1225.
33.
Takada Y, Uemoto S: Liver transplantation for hepatocellular carcinoma: the Kyoto experience. J Hepatobiliary Pancreat Sci 2010;17:527-532.
34.
Shirabe K, Aishima S, Taketomi A, Soejima Y, Uchiyama H, Kayashima H, Ninomiya M, Mano Y, Maehara Y: Prognostic importance of the gross classification of hepatocellular carcinoma in living donor-related Liver Transplant. Br J Surg 2011;98:261-267.
© 2013 S. Karger AG, Basel
2013
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.