Hepatocellular Cancer and Liver Transplantation: A Western Experience

Abstract

Orthotopic liver transplantation is the preferred treatment option in patients with hepatocellular carcinoma developing in chronic liver disease. Unfortunately, based on classical transplantation criteria (Milan criteria), only a minority of patients with hepatocellular carcinoma are candidate to orthotopic liver transplantation. Major improvements in treatment strategy and surgical technique including the use of neoadjuvant locoregional therapies and progresses of post-transplant immunosuppressive treatment have contributed to safely expand transplantation criteria preserving acceptable surgical morbidity-mortality and good oncologic outcome. Further extension of transplantation criteria may have advantages including an increase in the number of transplant candidates and improvement of the prognosis of the disease and also disadvantages including an increase of surgical morbidity and deterioration of global oncologic outcome of orthotopic liver transplantation in hepatocellular carcinoma. In the future, identification of imaging or molecular prognostic markers could help to better define transplantation criteria.

Low Serum Levels of (Dihydro-)Ceramides Reflect Liver Graft Dysfunction in a Real-World Cohort of Patients Post Liver Transplantation

“…In patients with end-stage liver disease, acute liver failure or selected cases of hepatocellular carcinoma (HCC), orthotopic liver transplantation (OLT) is often the last and sole available curative treatment [ 1 , 2 , 3 ]. Since the first successful OLT in 1967 [ 4 ] numerous aspects of pre- and post-OLT management have been improved, especially in terms of graft selection, surgeons’ techniques, ameliorated immunosuppressive therapy and early detection of complications [ 5 ].…”