Liver transplantation for hepatocarcinoma.

A total of 592 patients underwent orthotopic liver transplantation in the Cambridge/King's College Hospital series (January 1980 to May 1991). A total of 89 (15%) patients had either primary or secondary hepatobiliary malignancies. Of these, 66 were hepatocellular carcinoma (HCC) and 13 were cholangiocarcinoma. Of the HCC, 21 were cirrhotics and 45 were noncirrhotics. Eleven patients (12.6%) out of the total 89 died within 1 month without any evidence of recurrent tumor. The most common cause of death was due to postoperative hemorrhage. Of the patients with HCC, 21 (37.5%) had a recurrence of the original tumor and died of the malignancy from 2 months to 5 years after operation. At the time of writing, 18 patients are still alive and the overall 5-year survival rate was 18.6%. The 5-year survival recurrence in patients with HCC was 37.7% in cirrhotic livers. Some patients have been cured of primary malignancy of the liver. Our longest survivor has now survived for 17 years since undergoing transplantation. In 13 patients with cholangiocarcinoma, 6 (46.2%) died due to tumor recurrence and the 5-year survival rate was 23.8%. The indications for liver transplantation are therefore now rapidly expanding. Although the rate of recurrence is high and a long-term cure is rare, HCC remains an appropriate indication for liver transplantation.