Liver transplantation for hepatocellular carcinoma: outcomes and treatment options for recurrence

Overall survival and recurrence rates after liver transplantation (LT) for hepatocellular carcinoma (HCC) vary, however observational data support the notion that patients with HCC have an overall worse long-term prognosis after LT compared to patients transplanted without HCC. Patient selection for LT in patients with HCC fluctuated as changes in the model for end-stage liver disease score was adjusted from 2002 to 2005. In the last decade, management of HCC patients on the waiting list has varied based on center experience. Since HCC patients have better access to the donor pool compared to non-HCC patients as evidenced by their lower dropout rate from the waiting list, living donation has been implemented in certain centers. Overall patient survival, recurrence free survival, and recurrence rates have been compared between living donor LT (LDLT) and deceased donor LT, with one meta-analysis reporting a lower disease free survival in LDLT, however overall patient survival and recurrence rates showed no difference at 1, 3 and 5 years. In patients exhibiting HCC recurrence, different modalities regarding immunosuppression and therapies have been evaluated. Currently there are no consensus treatment strategies regarding post-transplant HCC recurrence in patients not suitable for locoregional therapy, hence consideration of a mammalian target of rapamycin inhibitors with the addition of sorafenib might be a feasible option with close monitoring in clinical practice despite the notable toxicities.