THE CURRENT STATUS OF LIVER TRANSPLANTATION FOR PRIMARY HEPATIC MALIGNANCY

Patients with liver cancer constitute an excellent population to enter transplantation programs at the beginning of the transplant era. The desperate situation of these individuals justified their inclusion in an experimental procedure. After demonstrating that orthotopic liver transplantation (OLT) was technically feasible and that the administration of cyclosporine could control rejection, it became clear that patients with malignant disease would have to be selected very carefully to avoid wasting livers in patients in whom the disease would recur almost immediately after the operation. This understanding prompted the exclusion of patients with metastatic disease or end-stage liver cancer involving major vessels or extrahepatic spread. Thus, the majority of patients with metastic involvement of the liver are excluded, and as a result the most frequently debated candidates are patients with hepatocellular carcinoma (HCC). The present article deals with the diagnosis, staging, and selection of patients with this neoplasm; other less frequent conditions, such as intrahepatic cholangiocarcinoma or epithelioid hemangioendothelioma, are briefly discussed.