Liver Transplantation for Non HCC Liver Malignancies

Abstract

Liver transplantation researches started before the 1960s with the baseline work of Thomas Starzl in Chicago and Boston, where the initial LT techniques were researched in dogs. Starzl attempted the first human LT in 1963 in Denver, but a successful LT was not achieved until 1967. In 1970, with an immunosuppressive regimen largely were dismal-approximately 15% at 1-year follow-up. LT did not become a clinical reality until the early 1980s, after the discovery of cyclosporine, which led to improvements in rejection rates. In 1983, the US National Institutes of Health established, by consensus, that LT was to be considered out of the experimental realm and was to be clinically accepted as definitive therapy for end-stage liver disease (ESLD). (Volk et al., 2011) The combination of improvements in rejection rates and in surgical technique led to an enormous expansion of the field during the 1980s, with expansion from 3 centers in 1982 to more than 120 centers today. In 1999, 4,500 procedures were performed, up from approximately 100 in 1982. (United Network for Organ Sharing [UNOS], 2009). Finally, the development of newer immunosuppressants, such as tacrolimus, has paved the way for further growth in this field. All these advances have produced excellent results, with current 1-year patient survival rates of 80-90% and 5-year survival rates of 62-80%. Future advances may include the development of cloning techniques and their impact on organ availability. [UNOS], 2009). Liver transplant for hepatocellular carcinoma has the potential to eliminate both the tumor as well as the underlying cirrhosis and is the ideal treatment for HCC in cirrhotic liver as well as massive HCC in noncirrhotic liver. Microvascular invasion is the single most important adverse prognostic factor for survival. Living donor liver transplantation has expanded donor options and has the advantage of lower waiting period and not impacting the non-HCC waiting list. Acceptable outcomes have been obtained with living donor liver transplantation for larger and more numerous tumors in the absence of microvascular invasion. Down staging of tumors to prevent progression while waiting for an organ or for reduction in size to allow enrolment for transplantation has met with variable success. (Kakodkar, Soin, 2012) Hepatoblastoma is the most common form of liver cancer in children, although it is a comparatively uncommon pediatric solid tumor. The disease usually affects children younger than 3 years.With advances in chemotherapy, surgical treatment, and postoperative care, the prognosis for children with hepatoblastoma has improved significantly during the past 3 decades. The combined use of liver transplantation and chemotherapy is now the preferred treatment option for unresectable HBL. In pediatric patients with hepatocellular carcinoma (HCC), transplantation has been associated with improved disease-free survival compared with conventional treatment with chemotherapy and resection, particularly in children with advanced-stage tumors or chronic underlying liver disease. (Cheng, Busuttil, 2015).