移植技術と研究

Salvage Liver Transplantation for HCC: An Old Story without Consensus?

Abstract

Gonzalo Sapisochin and Ramón Charco

Hepatocellular carcinoma (HCC), the most common liver tumor is a leading cause of mortality, accounting for more than 1 million deaths annually. Most HCC are diagnosed in association with liver cirrhosis, with the main risk factors being hepatitis B and C and alcohol abuse. In the past, HCC was diagnosed at advanced stages; no treatment could be applied and the prognosis was poor. Fortunately, as a result of screening programs in high-risk populations, patients with HCC are now diagnosed at an early stage, and up to 30% can be considered for a curative treatment. These curative treatments include liver resection (LR), liver transplantation (LT) and percutaneous ablation [1]. LT is the most effective treatment for patients with HCC since it removes the tumor and surrounding cirrhotic tissue, the main risk factor for the development of new tumors. Following the Milan criteria (single tumors = 5 cm or 3 tumors all of them = 3 cm), up to 75% 4-year survival has been described with a low recurrence rate (<10%) constituting the most extended criteria for LT for HCC [2]. Some groups have developed expanded criteria for LT for HCC such as the UCSF criteria and the up-to-seven criteria, with acceptable results.