Liver transplantation for hepatocellular carcinoma: past, present, and future

Hepatocellular carcinoma (HCC) is the fourth leading cause of cancer-related death globally. HCC is an aggressive disease with high fatality as reflected by the close numbers of annual deaths per year from HCC and annual incidence worldwide. In the United States, HCC incidence has increased substantially during the past two decades and is projected to continue to rise. Surgical resection remains the best treatment option for anatomically resectable tumors in patients with well-preserved liver function. For patients who are not resection candidates, liver transplantation offers treatment not only for HCC, but also for the cirrhotic liver. Liver transplantation for HCC is a rapidly evolving field. The results have dramatically improved with implementation of surveillance, careful selection of patients for transplantation, and pre-transplant tumor ablation. New promising tumor biomarkers, therapies for hepatitis C virus, molecular targeted therapies for HCC, and immunosuppression will ensure even better outcomes moving forward. This review discusses how liver transplant for HCC has changed over the many years, is currently improving, and how future research will shape better results.