Review articleIndications and limitations of liver transplantation for hepatocellular carcinoma
Section snippets
Liver transplantation for hepatocellular carcinoma
Hepatic resection is the usual standard treatment for suitable patients with HCC. Liver resection in patients with HCC and underlying cirrhosis is often limited by many factors, the most important of which is decreased hepatic functional reserve, which increases the risk of postoperative liver failure [29]. In addition, progression of liver disease and intrahepatic tumor recurrence are two added features that limit long-term survival after resection. One of the most important clinical
Methods for bridging to transplantation
Because of the risks of tumor progression while patients are waiting for transplant evaluation and for a donor organ, several strategies have been introduced to achieve local tumor control. These include percutaneous ethanol injection (PEI) for tumors that are less than 4 cm in diameter and transcatheter arterial chemotherapy (TACE), with or without embolization [40]. More recently, some centers have used percutaneous or laparoscopically directed tumor ablation using radiofrequency ablation
Methods to reduce tumor recurrence after transplantation
Several approaches have been used in an attempt to decrease the recurrence rate and improve the long-term survival after transplantation for patients who are found to have more advanced stage HCCs on pathologic examination of their explanted organ. The use of adjuvant chemotherapy has shown promising results in several series, although it is not considered standard therapy at the present time. Olthoff et al [57] reported a significant improvement in 3-year survival rates by using 5-FU,
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