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Indications for liver transplantation in hepatobiliary malignancy
R Pichlmayr1, A Weimann, B Ringe
1Klinik für Abdominal- und Transplantationschirurgie, Medizinische Hochschule Hannover, Germany.
Hepatology (Baltimore, Md.)
|July 1, 1994
Summary
Liver transplantation for hepatobiliary malignancy has specific indications and contraindications. Favorable cases include rare tumors and certain early-stage cancers, while advanced or metastatic disease is generally excluded.
Area of Science:
- Hepatology
- Surgical Oncology
- Transplant Surgery
Background:
- Hepatobiliary malignancy presents complex treatment challenges.
- Liver transplantation is a potential therapeutic option for selected patients.
- Defining clear indications is crucial for optimal resource allocation.
Purpose of the Study:
- To define current indications for liver transplantation in hepatobiliary malignancy.
- To review contraindications and borderline cases.
- To discuss the role of transplantation in advanced liver cancers.
Main Methods:
- Personal experience with 172 patients.
- Analysis of European Liver Transplant Registry data.
- Comprehensive review of recent medical literature.
Main Results:
- Contraindications include extrahepatic spread, cholangiocarcinoma, hemangiosarcoma, and nonendocrine metastases.
- "Favorable" indications encompass fibrolamellar carcinoma, epithelioid hemangioendothelioma, hepatoblastoma, and endocrine metastases.
- Tumor stages II and III hepatocellular and bile duct carcinomas represent further indications or borderline cases.
Conclusions:
- Transplantation for advanced intrahepatic tumors should be part of multimodality protocols.
- Early resectable hepatocellular carcinoma with cirrhosis warrants further controlled study.
- Split-liver transplantation can expand organ availability for tumor patients.