Liver transplantation and tumours: risks and outlook

Liver transplantation is the established therapy of choice for endstages of acute and chronic liver diseases of various aetiologies. The place of live r transplantation in the treatment of malignant liver disease, in particula r hepatocellular carcinoma, remains, however, debated: liver transplantatio n for hepatocellular carcinoma achieves S-year survival similar to that for other indications, and S-year disease-free survival better than that follo wing "curative" resection, provided certain criteria are fulfilled tone nod e max. 5 cm in diameter or max. 3 nodes each of max. 3 cm in diameter). Thi s must be weighed against the uncertainties of preoperative staging and the shortage of donor organs. In contrast, cholangiocarcinoma has a poor progn osis after liver transplantation with 3- and 5-year survival rates below 20 %. Only small, incidental, peripheral, intrahepatic cholangiocarcinomas in patients with primary sclerosing cholangitis seem to be an exception to thi s rule. Liver metastases indicate generalised tumour spread, and thus are n ot an indication for liver transplantation. Liver transplantation may be ju stified for liver metastases of neuroendocrine gastrointestinal tumours, pr ovided the primary has been curatively resected and there is no extrahepati c spread. Finally, liver-transplanted (immunosuppressed) patients are at in creased risk to develop malignant tumours. This includes in particular epit helial skin tumours, (EBV-associated lymphoproliferative diseases and (HHV8 -induced) Kaposi's sarcoma.