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Liver transplant for hepatocellular carcinoma |
Hépato-Gastro. Volume 15, Number 6, 425-33, Novembre-Décembre 2008, Mini-revue
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 Résumé
Texte intégral
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Author(s) : Thomas Decaens, Monika Hurtova, Christophe Duvoux |
Summary : Hepatocellular carcinoma (HCC) is currently the first indication for liver transplant (LT) accounting for 24% of indications in 2007 in France. Selection of the candidates relies on the principle of utility, which requires a 5-year survival rate of at least 50% and, for some authors, similar results to those obtained after LT for benign liver disease. The Milan criteria are the most commonly used for the selection of the patients, offering a 5-year survival and tumour recurrence rate of 75 and 10%, respectively. Their accuracy and predictive value are however not optimal yet, as some patients beyond these criteria can be cured by LT. Selection criteria must therefore be refined. Several new criteria have been proposed based on empirical analysis of retrospective series. Cautiously extending Milan criteria, they offer a probability of survival and recurrence close to those of Milan and would increase by 25% the number of HCC candidates. The identification of more specific criteria will be achieved by using additional parameters other than size and number of tumours. Allocation rules of liver graft, based on the MELD score, are not adapted to the HCC setting and must be adjusted to ensure the equity of allocation of the grafts between candidates. Although no study clearly demonstrates its efficacy, the treatment of HCC while on the waiting list could limit tumour growth and drop-out rate. It could have a beneficial impact on the risk of recurrence post-LT. |
Keywords : liver transplant, hepatocellular carcinoma, Milan criteria |
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