Transplantation for liver and biliary cancer

The early survival of patients transplanted for liver and biliary cancer is excellent, but the overall mid- to long-term survival is poor. In an era o f severe donor organ shortage, it is not justified to allocate donor liver to patients with a suboptimal outcome. Patients with nonresectable hepatoce llular carcinoma in a non-cirrhotic liver should not be assigned to liver t ransplantation. Although patients with the fibrolamellar variant have a som ewhat better outlook, they are still likely to recur, and the young age of many of these patients is likely to overwhelm any rational approach. The re sults of transplantation for early-stage hepatocellular carcinoma in a cirr hotic liver are similar to those achieved with benign disease. The inclusio n of such cases as a group is justified, but attempts should be made to res ect tumors whenever possible and to not assign the entire group to transpla ntation as the first and only option. The value of pre- and postoperative a djuvant therapy for this group is still under debate, but the present waiti ng period is so long that some form of therapy to slow growth and prevent d issemination of tumor cells is probably required. The results following tra nsplantation for cholangiocarcinoma can only be regarded as dismal, and the diagnosis of cholangiocarcinoma is a contraindication for the procedure. L iver transplantation has a definite place in the treatment of epithelioid h emangioendothelioma and unresectable chemo-responsive hepatoblastoma when c onfined to the liver, and in a limited number of metastatic neuroendocrine tumors. Semin. Surg. Oncol. 19:189-199, 2000. (C) 2000 Wiley-Liss, Inc.