Abstract

Liver transplantation is the prime management for early hepatocellular carcinoma with liver cirrhosis that is not candidate for surgical resection. Milan criteria, single tumor less than 5 cm or less than three tumors with less than 3 cm, is accepted as an indication for liver transplantation. The extended criteria do not show reliable result in long-term recurrent-free survival rate. Shortage of donor and following high drop-out rate during waiting time are main obstacle to liver transplantation, which can be alleviated by the living donor liver transplantation and priority policies in deceased donor liver allocation. The pre-operative loco-regional therapy, such as transarterial chemoembolization (TACE), radiofrequency ablation (RFA) and regional surgical resection, decreases the drop-out rate for waiting time and supplies time for preparing the liver transplantation. Generally acceptable recurrence rate after liver transplantation is less than 15%. The size of mass, vascular or lymphatic-invasion, low grade tumor and high pre-operative level of alpha-Fetoprotein (AFP) are risk factors for recurrence. The prognosis of recurred hepatocellular carcinoma is fatal. Neoadjuvant chemotherapy after liver transplantation cannot prolong the patient survival rate and decrease the recurrence rate. Above 50% of recurrence-free patient survival rate at post-transplant 5 years is reliable result after liver transplantation in hepatocellular carcinoma. The survival rate is improved after mid-1990, and is reported as 60-70% at post-transplant 5 years. The living donor liver transplantation shows more superior survival rate than deceased donor liver transplantation.

• Keywords: Hepatocellular carcinoma;Liver transplantation;Living donor;Recurrence