Background: The treatment of hepatocellular carcinoma (HCC) is challenging, but transplantation of the liver has emerged as one of the options in the therapeutic armamentarium against this disease.
Methods: This article reviews the changing criteria for patient eligibility for liver transplantation for HCC and presents an initial evaluation of institutional treatment outcomes for this treatment modality. A method for evaluating prognosis is also described.
Results: Patients are considered for liver transplantation if they meet the Milan criteria for eligibility or a UCSF-attributed expansion of these criteria that includes the "rule of 7, " whereby the sum of the size of the largest nodule plus the total number of nodules cannot exceed 7. Preliminary institutional experience suggests a tumor recurrence rate of 11% in 91 patients with HCC who received liver transplants between 1996 and 2008.
Conclusions: Liver transplantation offers an opportunity for long-term survival in patients with HCC and chronic cirrhosis whose tumor cannot be resected. Criteria for patient selection for this modality of treatment continue to be upgraded and refined.