Transplantation in hepatocellular carcinoma - controversies and recommendations: A review of current literature

Hepatocellular carcinoma (HCC) is the principal cause of death in patients with cirrhosis and the third leading cause of cancer-related death. HCC is present in around 80% of cirrhotic livers. Tumor recurrence and chronic liver failure are causative factors for mortality in the long term. Early liver transplantation (LT) for HCC with a significant tumor mass was associated with a poor prognosis owing to tumor recurrence. The vast experience and effectiveness of transplantation for HCC have sparked debates over whether the Milan criteria are overly stringent. The idea of tumor “downstaging,” expanding the limitations of tumor size, choice of either living related donor or cadaver donor transplantation, along with posttransplant care and its importance in HCC, are presently at the heart of a heated dispute. The recommendations in this article have attempted to highlight some of the disputed issues surrounding LT in HCC and may help programs in managing such patients better.