Liver transplantation for hepatocellular carcinoma: single nodule with Child-Pugh class A sized less than 3 cm

Hepatic resection (HR) has been the standard therapy for patients with small hepatocellular carcinoma (HCC) with preserved liver function in Child A cirrhosis. However, the underlying cirrhosis is responsible for high recurrence and long-term complications of portal hypertension and liver failure. Currently, liver transplantation (LT) has proven to be a good alternative to HR. We studied to determine whether LT could be an alternative initial therapy or not in HCC patients with less than 3 cm-sized, single nodule with Child A cirrhosis.

From January 1995 to December 2005, there were 100 HR and 17 LT (living donor LT 15, deceased donor LT 2) patients. Clinicopathologic characteristics were reviewed and survival rates between LT and HR groups were compared. The applicability of salvage LT at the time of recurrence was also evaluated.

There was no difference in age, sex, etiology and in-hospital mortality between the two groups. LTs were not performed for the patients with preserved liver function, that is, BCLC stage A1. Most initial recurrences after HR occurred in liver (37/39), but only one recurrence after LT occurred in lung. Overall survival differences between LT and HR were not significant. However, disease-free survival after LT and HR were significantly different (p = 0.047). Potential candidates for salvage LT were 37 patients including hepatic failure (n = 10), and its applicability on recurrence was 69.2% (27/39).

HR is still a good option for the selected patients because of lower cost and no requirement of donors. However, primary LT can be a treatment of choice for single, small HCC of Child A cirrhosis in the presence of portal hypertension because of excellent disease-free survival.