Liver transplantation for hepatic
malignancies has emerged as a well-documented and proven treatment modality. However, early unsatisfactory results emphasized that only a highly selected patient population would benefit from
transplantation. Currently, 15% of all
liver transplants performed are for
hepatocellular carcinoma (HCC). There is no controversy about the fact that
liver transplantation for HCC in the adult population yields good results for patients whose tumour masses do not exceed the Milan criteria. It remains to be determined whether patients with more extensive tumours can be reliably selected to benefit from the procedure. In patients with small HCC at an early stage and preserved liver function, liver resection provides an alternative to transplant. Liver resection may offer similar survival results to orthotopic
liver transplantation (OLT) in the short term, and does not carry the long-term effects of immunosuppression; however, long-term and disease-free survival favours
liver transplantation. Very promising results have been obtained for
cholangiocarcinoma treated by aggressive combination
therapies, including chemo- and
radiotherapy followed by OLT. Survival rate in these selected patients can approach that of patients with cholestatic
liver disease, and the role of
transplantation now requires re-evaluation. Similarly,
hepatoblastoma is an excellent indication in paediatric patients with unresectable or recurrent tumours.
Epithelioid hemangioendothelioma is also an appropriate indication for
liver transplantation, even in the presence of extrahepatic
metastases, unlike
angiosarcoma which is associated with a very poor survival and considered as a
contraindication. And finally for metastatic
liver disease from neuroendocrine tumours,
liver transplantation can result in long-term survival and even cure in well selected patients. Conversely, the value of
transplantation for colorectal liver
metastases (currently a
contraindication) requires further evaluation by well-designed trials.