Hepatocellular carcinoma accounts for more than 5% of all
malignancies with a continuous increase worldwide. The most important risk factor is
liver cirrhosis, frequently associated with hepatitis B virus or hepatitis C virus
infection. Liver resection is the only treatment that can potentially achieve cure. In carefully selected patients with a
tumor smaller than 5 cm the 5-year survival is around 50%. The presence of
liver cirrhosis and
portal hypertension limits the feasibility of hepatic resection. Child-Pugh A patients without major associated risk factors may be considered as the ideal target group for resection. A significant local disease recurrence rate of more than 70% at 5 years is the main problem of hepatic resection. Orthotopic
liver transplantation offers the possibility of removing a potentially multicentric
tumor and the underlying
end-stage liver disease. Due to pure selection of suitable candidates the initial reports on the efficacy of liver replacement in a cohort of patients with
hepatocellular carcinoma were disappointing. Taking the shortness of donor organs and the high posttransplant
tumor recurrence rate into account, several groups developed criteria qualifying
transplantation. A
tumor size of >6 cm and gross intrahepatic portal vein involvement seem to be of significant prognostic importance. Patients with smaller solitary
tumors or less than 3
tumors with a total
tumor diameter of <8 cm have the same survival after
transplantation as those with benign
liver disease. Living donor
liver transplantation offers a new approach to overcome the organ shortage and to theoretically extend the indication for
transplantation in
hepatocellular carcinoma.