Other / 14/05/2021

Can you get a liver transplant if you have HCC?

The only potentially curative treatment options are resection and liver transplantation. Among patients who are not candidates for liver resection, some who have cirrhosis and HCC are candidates for potentially curative liver transplantation.

What is cirrhosis HCC?

Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer. Hepatocellular carcinoma occurs most often in people with chronic liver diseases, such as cirrhosis caused by hepatitis B or hepatitis C infection.

Can Hep C cause HCC without cirrhosis?

HCC occurs rarely in non-cirrhotic hepatitis C virus (HCV) infection and there are no recommendations for screening in these patients.

What is locoregional therapy?

Locoregional therapies, defined as imaging-guided liver tumour-directed procedures, play a leading part in the management of 50–60% of HCCs. Radiofrequency is the mainstay for local ablation at early stages and transarterial chemoembolization (TACE) remains the standard treatment for intermediate-stage HCC.

Can a patient with hepatocellular carcinoma get a liver transplant?

Hepatocellular carcinoma (HCC) is the indication for ~30% of the liver transplants performed in the US and Europe Patients with T2 HCC (within Milan criteria) or those downstaged by locoregional therapy to within the Milan criteria are acceptable candidates for liver transplantation.

Which is the best liver transplant for patients with HCC?

Alpha‐foetoprotein (AFP) has repeatedly been shown to identify patients with HCC with a high risk of recurrence after LT. Patients with HCC within the Milan Criteria but an AFP >1000 ng/mL have a 5‐year recurrence‐free survival of only 20%.

Who are acceptable candidates for a liver transplant?

Patients with T2 HCC (within Milan criteria) or those downstaged by locoregional therapy to within the Milan criteria are acceptable candidates for liver transplantation. Treatment of concurrent chronic viral hepatitis in patients with HCC improves waiting list survival.

When to seek a liver transplant for cirrhosis?

In general, for patients with cirrhosis, one should consider referral for liver transplantation as they develop features of decompensated liver disease such as ascites, bleeding esophageal or gastric varices and hepatic encephalopathy that are not easily controlled with medical/endoscopic therapy. The MELD-sodium is also a general guide.

How are patients with cirrhosis of the liver treated?

There is a diversity of patients on the waiting list for transplantation and equity should be preserved between those with cirrhosis of high and intermediate severity and those with HCC. The management of patients on the waiting list is an essential component of the success of liver transplantation.