Experience with transplantation in the treatment of liver cancer

Thirteen patients with hepatic tumors, from the Boston Center for Liver Transplantation, have been transplanted among a total of 169 recipients. Ten were transplanted primarily for tumor, while three other patients harbored incidental tumors. Two perioperative deaths occurred (15%). Eight patients had hepatocellular carcinoma, one hepatoblastoma and four bile duct (Klatskin) tumors. Two of the bile duct cancers recurred with patient deaths at 9 and 10 months. The remaining nine patients are alive from between 1 month and 36 months postoperatively. A selected review of the literature allowed analysis of follow-up on 185 patients transplanted for tumor. Overall, the proportion of patients transplanted for tumor was 16%. Fifty-two percent of patients had hepatocellular carcinomas (HCC), 24% cholangiocarcinomas, 10% other primary liver tumors, and 14% metastatic hepatic tumors. Median survival for HCC was 1 year; 90-day mortality was 30%. Actuarial survival for 1, 2 and 3 years was 49%, 37% and 30% respectively. Fibrolamellar HCC and incidental HCC had significantly better results than other HCC. Tumor recurrence was present in 72% of autopsies after 90 days. Transplantation for HCC has satisfactory results in selected patients and may be improved by adjuvant chemotherapy. The median survival with cholangiocarcinomas was 8 months; 90-day mortality was 40%. Actuarial survival for 1 year was 36%. Recurrence was present in 100% of autopsies after 90 days. Survival after transplantation for this tumor was similar to that observed in patients not undergoing surgical treatment. Median survival for 18 other primary hepatic tumors was 16 months. Transplantation in carefully selected patients with these other primary tumors appears warranted. Although experience overall with transplantation for metastatic disease has been relatively unfavorable, each histological type must be considered independently.