Liver transplantation for hepatocellular carcinoma

Hepatocellular carcinoma (HCC) has been a major reason for liver transplantation (LT). Globally, LT for HCC is performed on the basis of the Milan criteria, and if performed within those criteria, then the outcome is not different from that of LT performed for other primary diseases. On the other hand, the scope of the Milan criteria covers only early-stage HCC, and many HCC patients do not meet the criteria even at the time of diagnosis. Therefore, over the last decade, efforts have been made to perform LT for patients whose clinical characteristics lie outside the Milan criteria. In Japan, more than 99% of LTs are living donor LTs (LDLTs) and more than 15% of LTs are performed in patients with HCC. The 1- and 3-year actual survival rates of LDLT for HCC in Japan are 82 and 79%, respectively. Efforts to extend the Milan criteria have also been made in Japan. To improve the outcome of LT for HCC, pre- and postoperative management of hepatitis B and hepatitis C, and immunosuppressant specific for this type of LT are still crucial issues. In this review, we provide an overview of current outcome, efforts to extend the Milan criteria, control of viral hepatitis, and immunosuppression for LT in patients with HCC.