Systematic review: the role of liver transplantation in the management of hepatocellular carcinoma

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Abstract
Summary: Background: Hepatocellular carcinoma (HCC) is a major cause of morbidity and mortality worldwide. Liver transplantation offers a potential cure for this otherwise devastating disease. The selection of the most appropriate candidates is paramount in an era of graft shortage.Aim: To review systematically the role of liver transplantation in the management of HCC in current clinical practice.Methods: An electronic literature search using PUBMED (1980–2010) was performed. Search terms included HCC, hepatoma, liver cancer, and liver transplantation.Results: Liver transplantation is a highly successful treatment for HCC, in patients within Milan criteria (MC), defined as a solitary tumour ≤50 mm in diameter or ≤3 tumours ≤30 mm in diameter in the absence of extra‐hepatic or vascular spread. Other eligibility criteria for liver transplantation are also used in clinical practice, such as the University of California, San Francisco criteria, with outcomes comparable to MC. Loco‐regional therapies have a role in the bridging treatment of HCC by minimising wait‐list drop‐out secondary to tumour progression. Beyond MC, encouraging results have been demonstrated for patients with down‐staged tumours. Post‐liver transplantation, there is no evidence to support a specific immunosuppressive regimen. In the context of an insufficient cadaveric donor pool to meet demand, the role of adult living donation may be increasingly important.Conclusions: Liver transplantation offers a curative therapy for selected patients with HCC. The optimisation of eligibility criteria is paramount to ensure that maximum benefit is accrued. Although wait‐list therapies have been incorporated into clinical practice, additional high quality data are required to support this strategy.

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