Liver Transplantation

Liver transplantation involves replacing a damaged liver, with a "donor" liver from a voluntary living or deceased donor. Liver transplantation in the United States for hepatocellular carcinoma is managed by the non-profit group United Network for Organ Sharing (UNOS). UNOS, which operates through 11 regions, allocates precious donor organs based on patient need, and research that shows which patients will survive the longest with a liver transplant. Individuals with HCC who can be considered for liver transplantation include those with one tumor no larger than 5cm, or 3 or fewer total tumors, and no tumors outside the liver or invading in large blood vessels. After liver transplantation, the recipient must take powerful drugs (immunosuppressants) that decrease their body's natural tendency to reject the new liver.

Hilar cholangiocarcinoma – cancers that originate where the left and right main bile ducts converge outside the liver – is now an indication for liver transplantation when treated before transplant, with 5-fluorouracil chemotherapy, external radiation, additional radiation given through the inside of the bile duct (neoadjuvant therapy). Patients undergo a staging abdominal exploration surgery after the neoadjuvant therapy and prior to transplantation. This staging operation is done to make sure that the tumor has not spread beyond the liver in which case transplantation would hurt rather than help the patient. The combination of neoadjuvant therapy, operative staging to rule-out regional metastases, followed by liver transplantation has achieved remarkable success for highly selected patients with early stage unresectable hilar cholangiocarcinoma and cholangiocarcinoma arising in the setting of primary sclerosing cholangitis.

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Bile duct cancer and cholangiocarcinoma

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Liver Transplantation