Published online May 14, 2014. doi: 10.3748/wjg.v20.i18.5331
Revised: December 31, 2013
Accepted: February 26, 2014
Published online: May 14, 2014
In 1967, Starzl et al performed the first successful liver transplantation for a patient diagnosed with hepatoblastoma. In the following, liver transplantation was considered ideal for complete tumor resection and potential cure from primary hepatic malignancies. Several reports of liver transplantation for primary and metastatic liver cancer however showed disappointing results and the strategy was soon dismissed. In 1996, Mazzaferro et al introduced the Milan criteria, offering liver transplantation to patients diagnosed with limited hepatocellular carcinoma. Since then, liver transplantation for malignant disease is an ongoing subject of preclinical and clinical research. In this context, several aspects must be considered: (1) Given the shortage of deceased-donor organs, long-term overall and disease free survival should be comparable with results obtained in patients transplanted for non-malignant disease; (2) In this regard, living-donor liver transplantation may in selected patients help to solve the ethical dilemma of optimal individual patient treatment vs organ allocation justice; and (3) Ongoing research focusing on perioperative therapy and anti-proliferative immunosuppressive regimens may further reduce tumor recurrence in patients transplanted for malignant disease and thus improve overall survival. The present review gives an overview of current indications and future perspectives of liver transplantation for malignant disease.
Core tip: Liver transplantation for malignancy is a medical and ethical challenge with regard to oncologic outcome and allocation justice. Childhood hepatoblastoma, epithelioid hemangioendothelioma, limited hepatocellular carcinoma and fibrolamellar carcinoma are proven indications for liver transplantation. Recent clinical trials have suggested cholangiocellular adenocarcinoma and hepatic metastases originating from neuroendocrine tumors as new indications in selected patients. Ongoing research may further widen indications for liver transplantation in malignant disease and therefore also complicate organ allocation. Living-donor liver transplantation may offer a solution for selected patients.