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Liver transplantation for recurrent hepatocellular carcinoma in Europe
S Jonas1, T Steinmüller, U Settmacher
1Department of General, Visceral and Transplantation Surgery, Charité-Campus Virchow Klinikum, Humboldt University, Augustenburger Platz 1, 13353 Berlin, Germany.
Background:
Patient death after liver resection for hepatocellular carcinoma in cirrhosis is caused by tumor recurrence as well as by complications of cirrhosis. Liver transplantation represents the only simultaneous treatment of tumor and primary liver disease. Certain criteria regarding the number (up to three) and size (up to 5 cm) of tumor nodules have to be observed in order to ensure a low risk of extrahepatic spread or vascular infiltration. Liver transplantation, as treatment for recurrent hepatocellular carcinoma, has to observe the same rules. Only few patients have undergone liver transplantation for recurrent hepatocellular carcinoma in cirrhosis. The reason for this restraint is not fully evident. Poor survival rates after liver transplantation as therapy for advanced hepatocellular carcinoma in the 1980s and an increasing shortage of donor grafts are certainly two factors.
Methods:
We report on two cases from our experience and review the European literature.
Results:
Outcome in a few selected patients has been rather favorable, despite varying approaches.
Conclusions:
The only conclusion that can be drawn is that tumor control by liver transplantation is possible in individual patients suffering from recurrent hepatocellular carcinoma. Adult living donor liver transplantation is one way to overcome graft shortage. Other strategies, for example, salvage transplantation, are presented.