Chronic end stage liver disease is the most frequent indication for liver transplantation. Individuals with end stage cirrhosis, and therefore individuals on liver transplant lists, are at increased risk of developing a hepatic cancer. Those individuals on liver transplant lists also may represent the best group available for evaluating the current methods for screening and surveillance for the development of hepatic cancer as an examination of the explant liver provides a gold standard for tumor assessment. Assuming that only tumor free individuals were screened at the onset of this study, the data obtained enables one to determine the frequency of new hepatic cancers since listing and evaluate the positive and negative predictive values of each assessment method over the surveillance interval. All patients listed for liver transplantation with end stage chronic liver disease, who did not have a hepatoma at the time of transplant listing, were followed and assessed for the development of a hepatic cancer while on the waiting list. The screening techniques utilized included quarterly ␣ fetoprotein (␣FP) determinations and ultrasound (US) studies as well as semi-annual triple phase computed tomography (CT) scans of the liver. ␣FP failed to identify any cases of de novo hepatic cancer in patients waiting for a liver transplant. In contrast, US and especially CT scanning with intravenous contrast identified new hepatic masses. The later method, which identified early enhancing mass lesions, was the more valuable method at identifying masses that subsequently were shown by pathologic examination of the explant liver to be hepatic cancers. However, only 14 of 20 individuals found to have a de novo tumor were identified by this method. Once identified however, the treatments utilized for hepatic tumor ablation while waiting for a transplant appear to be effective with a mean of 57.8؎8.3% necrosis of the treated masses being identified at the time of explant examination. In conclusion these data suggest that: T he major etiologic agents identified for the development of hepatocellular carcinoma (HCC) in the western world are chronic hepatitis C virus (HCV) infection and chronic alcohol abuse. 1 -16 Worldwide, particularly in Asia and Africa, the leading etiologic agent for the development of HCC is the presence of a chronic hepatitis B infection. 3,4,7,8,12,13 Chronic hepatitis C appears to be responsible for the recent increase in prevalence of HCC in the United States 5,6 and in other unique groups. 9 -11 HCC is also a well-recognized complication of cirrhosis in individuals with the various toxin exposures particularly alcohol but also other environmental toxins. 1,2,9,16,17 Finally, HCC occurs in cases of advanced endstage liver disease regardless of the etiology. 1,2,9,10,14,15 Thus, candidates for liver transplantation on a waiting list are a unique population at risk for the development of HCC. Despite this fact, the rate of de novo HCC development in liver transplant candidates listed for transplantation is cu...

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