Transplantation for Hepatocellular Carcinoma

Hepatocellular carcinoma (HCC) is the third leading cause of cancer mortality world‐ wide, accounting for more than 500,000 deaths annually. Major risk factors include chronic liver disease and liver cirrhosis due to hepatitis B and C viral infections, alcoholic liver disease and non-alcoholic steatohepatitis (NASH). Surgical resection and liver transplanta‐ tion are the only potentially curable options for patients with HCC. While surgical resection is the treatment of choice in patients with good hepatic function, it is contraindicated in those with moderate to severe cirrhosis (Child class B or C), leaving these patients with liver transplantation as the only option. Moreover, transplantation is the optimal treat‐ ment even for small, otherwise resectable disease. This is a reflection of a number of factors. Liver transplantation will most likely result in a microscopically negative resection, which is the most effective oncologic treatment. Most HCCs are multifocal especially in the background of cirrhosis, though pre-neoplastic lesions may not be visible on periopera‐ tive evaluation; they are likely to continue to evolve into new primary HCCs. Further‐ more, transplantation eliminates cirrhosis and restores normal hepatic function. However, limited organ availability mandates the restriction of liver transplantation to patients with early stage tumors who are not candidates for resection.