Liver Transplantation for Other Cancers

The first seven cases of liver transplantation were performed during 1963-1964. The indication for six of these procedures was malignancy, and three of these cases involved duct cell carcinomas and colon metastases. The results after this first experience were unsatisfactory and it was not until late 1990s, after the Milan multicenter study, that liver transplantation became a standard indication for hepatocellular carcinoma (HCC). Currently, patients with HCC who meet Milan criteria have been found to have comparable results in terms of survival to patients with cirrhosis and no malignancy. In addition, promising results have been shown after downstaging for HCC in patients initially beyond Milan criteria. There are a few additional, although very uncommon, indications for liver transplantation in patients with cancers other than HCC. In the U.S., these include hilar cholangiocarcinoma, liver metastases from neuroendocrine tumors in the GI tract, unresectable tumors including hemangioendothelioma, large and/or multifocal hepatic adenoma, and unresectable hepatoblastoma in children, but all in a highly selective fashion. Improvements in resection techniques, the shortage of the donor pool, and the potential risk of recurrence enhanced by immunosuppression therapy after transplantation are some of the reasons why liver transplantation for malignancy is considered only in a highly selected way in such patients. In addition there is a great deal of center to center variability in the use of transplantation for such non-standard indications. Besides these features, the development of systemic therapies and well-defined protocols of chemoradiation before and after liver transplantation has played a role in protocol development in many of these transplant indications.