Liver transplantation for hepatocellular carcinoma: lessons learned and future directions

The past 2 decades have witnessed an exponential increase in the incidence of hepatocellular carcinoma (HCC) in the United States and, concurrently, the development of liver transplantation as an effective modality in its treatment. "Early" HCC has been defined, allowing patients with unresectable HCC to be granted priority for transplant over the past decade. This situation has produced a dramatic increase in the number of transplants for HCC. The challenge has been how to expand the indications of liver transplant for HCC with improved cancer-free survival and fewer transplant-related complications without adversely affecting non-HCC transplant candidates.