Emerging role of transplantation for primary liver cancers.

Abstract Liver transplantation (LT) has been utilized in the treatment of primary hepatic malignancy for decades. Hepatocellular cancer (HCC) remains the most common malignant condition treated with LT, with almost 400 such transplants performed annually in the US. Refinement in the selection criteria for LT in patients with HCC has led to survival rates similar to those for LT in nonmalignant conditions. Excellent results have also been reported following LT for select patients with epithelioid hemangioendothelioma and hepatoblastoma. Patients with cholangiocarcinoma treated with LT have generally faired poorly, with survival rates far below that of LT for nonmalignant conditions. Improved survival has recently been reported following LT for cholangiocarcinoma in highly select patients treated with aggressive neoadjuvant therapy. The future utility of LT in the treatment of malignancy will be influenced by several factors, including a profound organ donor shortage faced worldwide; increasing prevalence of hepatitis C, HCC and cirrhosis; and the evolution of live donor liver transplantation. Liver transplantation has been used for several decades in the treatment of hepatic malignancy. Removal of the entire liver has obvious appeal in patients with hepatic tumors that are not amenable to or have failed to respond to other treatment options. Several factors must be considered when considering LT for a patient with malignancy, including riss of surgery and post operative immunosuppression, donor organ availability and allocation, and assessment of acceptable outcomes. This chapter reviews the role of LT in the treatment of primary hepatic malignancies and provides a brief description of the issues surronding LT organ allocation policies. With exception of metastatic neuroendocrine tumors, secondary hepatic malignancies do poorly with LT and are not discussed here.