[Liver transplantation for cancer]

Area of Science:

• Hepatology
• Transplant Surgery
• Oncology

Background:

• Hepatocellular carcinoma (HCC) is a primary indication for liver transplantation (LT).
• For resectable HCC, LT and conventional therapies show similar 5-year survival, but LT offers better recurrence-free survival.
• The Milan criteria are standard for selecting HCC patients for LT, aiming for a recurrence risk below 15%.

Purpose of the Study:

• To discuss the role of liver transplantation in managing hepatocellular carcinoma.
• To explain the 'liver score' system for ranking patients on the liver transplant waiting list.
• To review marginal indications for LT, including specific cancers and patients with prior extrahepatic malignancies.

Main Methods:

• Review of current practices and criteria for liver transplantation in HCC.
• Description of the components of the 'liver score,' including MELD and HCC-specific factors.
• Analysis of outcomes for LT in patients with specific tumor types and a history of extrahepatic cancer.

Main Results:

• LT provides superior recurrence-free survival for HCC compared to resection or ablation.
• The 'liver score' integrates cirrhosis severity (MELD-based) and HCC burden for waiting list prioritization.
• LT is feasible for selected patients with a history of extrahepatic cancer, showing a low recurrence risk (<5% at 10 years).

Conclusions:

• Liver transplantation is a critical treatment option for HCC, especially when aiming to minimize recurrence.
• The 'liver score' provides a structured approach to LT waiting list management.
• Careful patient selection allows for successful LT in cases with marginal indications, including prior extrahepatic malignancies.