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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Jun 8, 2015; 7(10): 1347-1354
Published online Jun 8, 2015. doi: 10.4254/wjh.v7.i10.1347
Liver transplantation as a management of hepatocellular carcinoma
Ayman Zaki Azzam
Ayman Zaki Azzam, Department of General Surgery, Faculty of Medicine, Alexandria University, Alexandria 21526, Egypt
Author contributions: Azzam AZ solely contributed to this paper.
Conflict-of-interest: The other authors have no conflicts of interest or financial ties to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Ayman Zaki Azzam, MD, PhD, Department of General Surgery, Faculty of Medicine, Alexandria University, 22 Al-Guish Avenue, Alexandria 21526, Egypt. aazzam70@yahoo.com
Telephone: +966-11-4647272 Fax: +966-11-4423941
Received: August 28, 2014
Peer-review started: August 29, 2014
First decision: October 14, 2014
Revised: March 17, 2015
Accepted: April 1, 2015
Article in press: April 7, 2015
Published online: June 8, 2015
Abstract

Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide and has a poor prognosis if untreated. It is ranked the third among the causes of cancer-related death. There are multiple etiologic factors that can lead to HCC. Screening for early HCC is challenging due to the lack of well specific biomarkers. However, early diagnosis through successful screening is very important to provide cure rate. Liver transplantation (LT) did not gain wide acceptance until the mid-1980s, after the effective immunosuppression with cyclosporine became available. Orthotopic LT is the best therapeutic option for early, unresectable HCC. It is limited by both, graft shortage and the need for appropriate patient selection. It provides both, the removal of tumor and the remaining cirrhotic liver. In Milan, a prospective cohort study defined restrictive selection criteria known as Milan criteria (MC) that led to superior survival for transplant patients in comparison with any other previous experience with transplantation or other options for HCC. When transplantation occurs within the established MC, the outcomes are similar to those for nonmalignant liver disease after transplantation. The shortage of organs from deceased donors has led to the problems of long waiting times and dropouts. This has led to the adoption of extended criteria by many centers. Several measures have been taken to solve these problems including prioritization of patients with HCC, use of pretransplant adjuvant treatment, and living donor LT.

Keywords: Hepatocellular carcinoma, Management, Liver transplantation, Pretransplant adjuvant therapy, Milan criteria

Core tip: Hepatocellular carcinoma (HCC) has a poor prognosis if untreated. Screening is challenging due to the lack of specific biomarkers. Successful screening is very important as early diagnosis can provide curative opportunities. Orthotopic liver transplantation (LT) is the best therapeutic option for early, unresectable HCC. When transplantation occurs within the established Milan criteria, the outcomes are good. The shortage of organs from deceased donors led to the adoption of extended criteria. Several measures have been taken to solve these problems including prioritization of patients with HCC, use of pretransplant adjuvant treatment, and living donor LT.