[Liver transplantation for hepatocellular carcinoma]

Since the hepatocellular carcinoma (HCC) develops in cirrhotic liver and is often multicentric, liver transplantation (LT) seems to be a rational approach for the treatment of HCC. Current selection criteria of LT for HCC are Milan criteria (single nodule < or = 5 cm , or < or = 3 nodules and < or = 3 cm each, without major vessel invasion and metastasis). Four-year survival rate in patients within Milan criteria was 75% after LT, which was comparable with that of transplant candidates without HCC. Expanding selection criteria beyond Milan results in more patients with HCC being cured at the expense of a higher incidence of recurrence. The molecular/biologic information of individual tumors will be useful to reduce the recurrence in the future. Transarterial chemoembolization, local ablative therapy, and even surgical resection can be performed to prevent tumor progression and sometimes provide a chance of biologic selection of HCC while waiting for liver transplantation. In Korea, the cadaver donor shortage is severe and cadaveric liver transplantation for HCC patients is exceptional. Living donor LT is a more popular approach for these patients in Korea. However, many controversial issues have been raised about live donor safety and expansion of criteria in living donor LT. In the future, with better understanding of tumor biology, we could select a better group of patients who would not recur cancer after LT.