Liver Transplantation for Hepatocellular Carcinoma: The Challenge of Organ Availability

Abstract

Liver transplantation provides potentially definitive therapy for patients with end-stage liver disease and hepatocellular carcinoma (HCC). Application of liver transplantation to HCC patients is limited by scarce donor organ supply and is dictated by organ allocation policy. In the United States, organ allocation policy for HCC patients has evolved in an effort to balance access to transplant and survival outcomes among HCC patients with those of patients with other indications for transplant. Currently, UNOS criteria for allocation priority to HCC patients are restricted to patients with T2 tumors. Transplanting patients with more advanced HCC is associated with increased recurrence rates and diminished posttransplant survival. Downstaging patients with more advanced HCC to within Milan criteria is appropriate as long as appropriate periods of observation after liver-directed therapy and prior to transplant are maintained. Living donor liver transplantation (LDLT) is appropriate for select patients with HCC, although optimal recipient selection for LDLT among HCC candidates is not yet defined.