Liver transplantation and hepatocellular carcinoma

Liver transplantation for advanced hepatocellular carcinoma (HCC) continues to be a subject of debate mostly due to a uniformly high failure rate secondary to recurrence. However, accumulating experiences have enabled detailed analysis of the prognostic factors affecting patient outcome. Clinicopathological factors affecting survival have been reported to include tumor size, number, lobar distribution, vascular invasion, lymphnode metastasis, and histologic type such as fibrolamellar variant of HCC. Poor prognosis has been associated with advanced stage of the tumor, particularly pTNM stage IV. Many transplant centers now use a protocol of adjuvant chemotherapy with reasonable success, although experiences are limited. Better understanding in tumor biology, particularly of the role of immunosuppression affecting tumor growth, will provide further success in the treatment of HCC by liver transplantation.