Expanded criteria for liver transplantation in patients with hepatocellular carcinoma

Liver transplantation is the only curative treatment for patients with cirrhosis and unresectable hepatocellular carcinoma (HCC) without extrahepatic dissemination. Since criteria for transplantation in HCC are controversial, we evaluated our early results of liver transplantation for unresectable HCC.

Three women and 14 men (age range, 1.1 to 64 years) with preoperatively diagnosed or incidentally discovered HCC underwent liver transplantation. Six grafts were obtained from cadaveric donors, and each of the remaining 11 grafts from a living related donor. Criteria for participation, independent of tumor size and number of tumor nodules, were no invasion of major vascular structure and no evidence of extrahepatic disease. In nine patients, tumors were beyond the Milan criteria. Twelve patients (86.7%) received tacrolimus and 2 (13.30%), rapamycin monotherapy with early withdrawal of corticosteroid therapy. Two patients underwent neoadjuvant chemoembolization before transplantation; none received adjuvant chemotherapy. Seven patients with hepatitis B virus infection underwent antiviral prophylaxis with antibody to hepatitis B surface antigens and lamivudine.

During follow-up (range, 1 to 17 months), all patients exhibited excellent graft function. Imaging studies revealed no evidence of tumor recurrence and no elevation of alpha fetoprotein or carcinoembryonic antigen levels.

Low-dose immunosuppressive therapy and expanded criteria for liver transplantation in patients with HCC, especially when donation from a living related donor is possible, appear to inhibit disease recurrence and improve outcomes.