INDICATIONS FOR LIVER-TRANSPLANTATION IN HEPATIC NEOPLASMS

Orthotopic liver transplantation for hepatic neoplasms is controversia l. In the past, liver transplantation was utilized to treat various ad vanced hepatic neoplasms such as hepatocellular carcinoma including th e fibrolamellar variant, cholangiocellular carcinoma, epitheloid heman gio-endothelioma, and liver metastases. In many cases, total hepatecto my with orthotopic liver replacement is the only treatment option with intent to cure because of reduced liver function in cirrhotic patient s limiting resectability. On the other hand, results of transplantatio n are poor; for hepatocellular carcinoma, the 5-year-survival probabil ity averages only 20%. Thus, hepatic neoplasms have to compete with be nign liver diseases for a limited supply of donor organs. However, suc cess rates of liver transplantion were higher for fibrolamellar carcin oma and for epitheloid hemangioendothelioma. New treatment strategies for hepatocellular carcinoma including neoadjuvant chemotherapy and ch emoembolization are currently being investigated. Results of liver tra nsplantation for cholangiocellular carcinoma or hepatic metastases hav e been disappointing. Single cases have been successfully treated with the ''cluster operation'' designed by Starzl in 1988.