J Korean Soc Transplant.  2010 Mar;24(1):4-12. 10.4285/jkstn.2010.24.1.4.

Liver Transplantation for Advanced Hepatocellular Carcinoma

Affiliations
  • 1Center for Liver Cancer, National Cancer Center, Goyang, Korea.
  • 2Department of Surgery, Seoul National University, College of Medicine, Seoul, Korea. kssuh@snu.ac.kr

Abstract

Hepatocellular carcinoma (HCC) has become an important indication for liver transplantation in Korea. Even though the Milan criteria have been accepted as the gold standard in deceased donor liver transplantation, the acceptable indication for living donor liver transplantation is controversial. This review covers several key issues in liver transplantation for advanced HCC: (1) recent developments and published data on expanded criteria, (2) the role of down-staging, (3) an ethical issue in expanding the criteria in living donor liver transplantation, and (4) post-operative management, including the immunosuppressive regimen and post-transplant adjuvant chemotherapy to improve survival after transplantation for advanced HCC. Biological factors, such as AFP, PIVKA-II, and a PET scan, in addition to tumor size and number, may be helpful in selecting eligible patients for liver transplantation among patients with advanced HCC. Low-level immunosuppression with low exposure of calcineurin inhibitor may reduce HCC recurrence after transplantation.

Keyword

Advanced hepatocellular carcinoma; Expanded criteria; Immunosuppressive regimen; Liver transplantation
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