Transplantation for Hepatocellular Carcinoma

Transplantation for HCC is a broad and complex topic due to the many fold considerations of both donor organ selection and recipient. Although it is known that tumor size is negatively associated with post-transplant outcome, the exact cutoff is difficult to determine. Much progress has been made in this field trying to strike the proper balance between good post-transplant survival, longer recurrence-free survival and fair allocation of livers, but more work is necessary. Tumor downstaging has allowed far more HCC transplants to occur and further advances in liver-directed therapy will likely increase this number. The use of new technologies such as SBRT for downstaging will increase the number of transplant candidate and machine perfusion promises to make more organs available to them. The progress of transplantation for HCC is a model for transplantation of other liver tumors such as cholangiocarcinoma and isolated colorectal liver metastases.