[Liver transplantation for hepatocellular carcinoma and for patients with pre-existing cancers]

Presse Med. 2009 Sep;38(9):1272-80. doi: 10.1016/j.lpm.2009.05.001. Epub 2009 Aug 11.
[Article in French]

Abstract

Hepatocellular carcinoma (HCC) is currently the leading indication for liver transplantation in France, accounting for 25% of all cases. Transplantation is appropriate, nonetheless, only for patients whose HCC has a low risk of posttransplant recurrence and is limited in size and number, meeting the Milan criteria (1 single nodule of a maximum diameter of 5 cm or 3 lesions of a maximum diameter of 3 cm), or slightly exceeds these criteria without vascular invasion visible on preoperative imaging. Results for this indication are very satisfactory, and 5-year survival ranges from 60 to 80%, according to tumor stage. Small HCCs (<2 cm) are usually treated conservatively. Transplantation is proposed in cases of a contraindication to resection or radiofrequency ablation or of recurrence after local treatment. A history of an extrahepatic tumor is found in approximately 5% of candidates for liver transplantation. This history is not necessarily a contraindication to transplantation. They may be considered eligible for a graft after discussion in a multidisciplinary meeting, if the extrahepatic tumor was treated curatively and if their 5-year tumor-related life expectancy is greater than 50-60%.

MeSH terms

  • Carcinoma, Hepatocellular / pathology
  • Carcinoma, Hepatocellular / surgery*
  • Contraindications
  • Humans
  • Immunocompromised Host / immunology
  • Kidney Transplantation / immunology
  • Life Expectancy
  • Liver Cirrhosis / surgery
  • Liver Neoplasms / pathology
  • Liver Neoplasms / surgery*
  • Liver Transplantation / mortality
  • Liver Transplantation / standards*
  • Neoplasm Recurrence, Local* / immunology
  • Neoplasm Recurrence, Local* / prevention & control
  • Neoplasm Recurrence, Local* / therapy
  • Neoplasm Staging
  • Neoplasms, Multiple Primary* / immunology
  • Patient Selection
  • Practice Guidelines as Topic
  • Precancerous Conditions / surgery
  • Tumor Burden