BACKGROUND: Orthotopic liver transplantation (OLT) plays a pivotal role in the management of selected patients with initial hepatocellular carcinoma (HCC). After disappointing early results and a shortage of cadaveric grafts, patients are currently selected for OLT on the basis of tumour size and number. Limitations of these criteria and the advent of living donation have prompted their re-evaluation. The principal aims of this review were to define the limitations of current transplant criteria for HCC, and to identify potential areas for improvement. METHODS: A Medline search using the terms 'liver transplantation' and 'hepatocellular carcinoma' was conducted. Additional references were sourced from key articles. RESULTS AND CONCLUSION: In patients with HCC, biological properties of the tumour are more accurate than radiological criteria in determining outcome after transplantation. Despite the risks of tumour biopsy, which may have been previously overstated, histological evaluation before transplantation may have a role and warrants further study. By expanding the donor pool and eliminating waiting times, live donor liver transplantation is a valuable resource that has yet to fulfil its potential because of unresolved ethical issues concerning the safety of the donor. The availability of long-term outcome data may help to clarify this in the near future. Copyright 2005 British Journal of Surgery Society Ltd.
BACKGROUND: Orthotopic liver transplantation (OLT) plays a pivotal role in the management of selected patients with initial hepatocellular carcinoma (HCC). After disappointing early results and a shortage of cadaveric grafts, patients are currently selected for OLT on the basis of tumour size and number. Limitations of these criteria and the advent of living donation have prompted their re-evaluation. The principal aims of this review were to define the limitations of current transplant criteria for HCC, and to identify potential areas for improvement. METHODS: A Medline search using the terms 'liver transplantation' and 'hepatocellular carcinoma' was conducted. Additional references were sourced from key articles. RESULTS AND CONCLUSION: In patients with HCC, biological properties of the tumour are more accurate than radiological criteria in determining outcome after transplantation. Despite the risks of tumour biopsy, which may have been previously overstated, histological evaluation before transplantation may have a role and warrants further study. By expanding the donor pool and eliminating waiting times, live donor liver transplantation is a valuable resource that has yet to fulfil its potential because of unresolved ethical issues concerning the safety of the donor. The availability of long-term outcome data may help to clarify this in the near future. Copyright 2005 British Journal of Surgery Society Ltd.
Authors: Kathy Han; George N Tzimas; Jeffrey S Barkun; Peter Metrakos; Jean L Tchervenkov; Nir Hilzenrat; Phil Wong; Marc Deschênes Journal: Can J Gastroenterol Date: 2007-01 Impact factor: 3.522
Authors: Sudeep Tanwar; Shahid A Khan; Vijay Paul Bob Grover; Catherine Gwilt; Belinda Smith; Ashley Brown Journal: World J Gastroenterol Date: 2009-11-28 Impact factor: 5.742
Authors: Adam St J R Bartlett; John L McCall; Jonathan B Koea; Andrew Holden; Mee-Ling Yeong; Nishanthi Gurusinghe; Ed Gane Journal: World J Surg Date: 2007-07-04 Impact factor: 3.352