[Indications for liver transplantation in neoplasms of the liver]

Orthotopic liver transplantation for hepatic neoplasms is controversial. In the past, liver transplantation was utilized to treat various advanced hepatic neoplasms such as hepatocellular carcinoma including the fibrolamellar variant, cholangiocellular carcinoma, epithelioid hemangio-endothelioma, and liver metastases. In many cases, total hepatectomy with orthotopic liver replacement is the only treatment option with intent to cure because of reduced liver function in cirrhotic patients limiting resectability. On the other hand, results of transplantation are poor; for hepatocellular carcinoma, the 5-year-survival probability averages only 20%. Thus, hepatic neoplasms have to compete with benign liver diseases for a limited supply of donor organs. However, success rates of liver transplantation were higher for fibrolamellar carcinoma and for epithelioid hemangioendothelioma. New treatment strategies for hepatocellular carcinoma including neoadjuvant chemotherapy and chemoembolization are currently being investigated. Results of liver transplantation for cholangiocellular carcinoma or hepatic metastases have been disappointing. Single cases have been successfully treated with the "cluster operation" designed by Starzl in 1988.