Liver transplantation for hepatocellular carcinoma in patients without underlying liver disease: A systematic review

Liver resection is the treatment of choice for hepatocellular carcinoma (HC C) occurring in the absence of underlying chronic liver disease. Orthotopic liver transplantation (OLT) is reserved for patients with unresectable dis ease but remains controversial. The aim of this study was to review the pub lished literature on OLT for HCC in patients without coexisting chronic liv er disease. A Medline-based search identified 126 patients reported in 16 p apers over the last 32 years, One third had fibrolamellar HCC (FL-HCC), and two thirds had non-FL-HCC. Recurrence data were given in 55 patients of wh om 27 had tumor recurrence, Seventy-five percent of the recurrences occurre d within the first 2 years after OLT, although recurrences were reported up to 72 months after OLT for FL-HCC. The 5-year survival rate was greater in patients who underwent transplantation for FL-HCC than for non-FL-HCC (39. 4% and 11.2%, respectively). There was insufficient information available t o determine the influence of tumor size, distribution, stage, and vascular invasion on survival, although most patients in whom tumor characteristics were specified had advanced disease. This study indicates that FL-HCC carci noma is a more favorable indication for OLT than non-FL-HCC in patients wit hout underlying liver disease, although more detailed prognostic informatio n is required to improve patient selection, Copyright (C) 1999 by the Ameri can Association for the Study of Liver Diseases.