Liver transplant for hepatocellular cancer: a treatment for the select few

Hepatocellular cancer (HCC) is increasing in incidence and liver transplant (LT) is likely the best treatment for long-term survival and decreased recurrence in those with localized disease. Optimal treatment for HCC is limited by advanced stage at presentation and available donors. We retrospectively reviewed 232 cases of HCC from 1993 to 2002 referred to our medical center, which also has the only transplant program in the state. Demographic data, risk factors, stage, previous treatment, candidacy for LT, and outcome were noted. Stage distribution was as follows: stage I - nine patients, II - 115 patients, III - 31 patients, and IV - 76 patients. Mean age was 61.1 yr and 62 patients were over the age of 70 yr. Thirty-five patients (15.1%) were offered LT evaluation. Nineteen patients (8.2%) eventually underwent LT, five are currently on a transplant waiting list, three were on a list but removed due to death or progression of disease, six were evaluated but not listed, and two refused evaluation. Five patients were transplanted because implementation of the Model of End-stage Liver Disease (MELD) system for organ allocation. Of 19 patients who underwent LT, 14 are still alive 3-52 months post-transplant, three developed recurrent HCC, and two died of lung cancer. Although LT may be the best treatment for HCC, a relatively small number of patients (15%) will qualify for this therapy. About half of those who qualify will actually undergo LT. This further emphasizes the need for other strategies such as vaccination, chemoprevention, and early detection to improve survival from HCC.