Liver transplantation in primary liver tumors

As transplant medicine has evolved in recent decades so too have the indications for liver transplantation (LT). Active or suspected malignancy has stopped being considered as a contraindication for organ transplantation, and nowa­days LT plays a major role in the treatment strategies of liver tumors. It offers excellent long-term outcomes for certain patients with hepatocellular carcinoma (HCC) and carefully selected patients with cholangiocarcinoma (CCA), who undergo neoadjuvant chemoradiatotherapy. In certain clinical courses of rare primary liver tumors, hepatic epithelioid haemangio-endothelioma (HEHE) and hepatic adenoma (HA), liver transplantation is also considered the best treatment option. Optimal patient selection has become the key issue to achieve the best possible outcomes and to deal with the alleviating shortage of organs. The recent tendency to incorporate markers of tumor biology into selection criteria, rather than simply focusing on tumor size and number, has led to further extension of indications for LT in patients with liver malignancy. This review article focuses on the current place of liver transplantation in the treatment strategy for patients with primary liver tumors, mainly primary liver cancers.