[Liver transplantation for hepatocellular carcinoma and for patients with pre-existing cancers]

Hepatocellular carcinoma (HCC) is currently the leading indication for liver transplantation in France, accounting for 25% of all cases. Transplantation is appropriate, nonetheless, only for patients whose HCC has a low risk of posttransplant recurrence and is limited in size and number, meeting the Milan criteria (1 single nodule of a maximum diameter of 5 cm or 3 lesions of a maximum diameter of 3 cm), or slightly exceeds these criteria without vascular invasion visible on preoperative imaging. Results for this indication are very satisfactory, and 5-year survival ranges from 60 to 80%, according to tumor stage. Small HCCs (<2 cm) are usually treated conservatively. Transplantation is proposed in cases of a contraindication to resection or radiofrequency ablation or of recurrence after local treatment. A history of an extrahepatic tumor is found in approximately 5% of candidates for liver transplantation. This history is not necessarily a contraindication to transplantation. They may be considered eligible for a graft after discussion in a multidisciplinary meeting, if the extrahepatic tumor was treated curatively and if their 5-year tumor-related life expectancy is greater than 50-60%.