Liver transplantation for hepatocellular carcinoma: indications, bridge therapy and adjuvant therapy

Hepatocellular carcinoma (HCC) is a major cause of cancer mortality worldwide, and its incidence is increasing in the United and States. Liver transplantation has the potential to improve survival for patients with HCC. Unfortunately, not enough donor livers are available to meet demand for liver transplantation. The Milan Criteria were established to provide candidate selection guidelines for liver transplantation in patients with HCC. Well-established oncologic therapy for HCC ("bridge therapy") has the capacity to suspend tumor progression and to allow HCC patients to maintain active candidacy as long as necessary to obtain a liver. Several techniques are utilized as bridge therapies for HCC patients awaiting liver transplantation. Adjuvant therapies after liver transplantation may reduce HCC recurrence, and may be required for patients with tumors having high-risk biologic or histologic features. Selection criteria, adjunctive techniques, and outcomes in liver transplantation for HCC patients are described.