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.