|
Liver Transplantation
 Historically liver transplantation for hepatocellular cancer has been done since the inception of the technology of liver transplantation. In the early days, the idea was to transplant patients who were in the very late stage of liver cancer (i.e. those tumors that involved both lobes of the liver and were quite extensive). As the data began to accumulate it became apparent that a better strategy was to transplant patients who had cirrhosis with early stage cancer since in the later stages the patients were no longer curable and the cancer usually reoccurred within the first year if the tumor were in the late stages.
The current strategy in liver transplantation embraces this philosophy, that is:
To identify patients who have early stage tumors and then promptly list them for transplantation so that they could be transplanted before the disease progresses within the liver, and decrease the likelihood of it spreading to other locations outside the liver.
For that reason, patients who have cirrhosis and are considered to be at high risk for development of hepatocellular cancer; specifically those with Hepatitis B, C, hemachromatosis, alpha 1-antitripsin deficiency, and any patient with cirrhosis are screened on a regular basis in order to identify tumors at an early stage before they have progressed to a stage where a patient is no longer transplantable for cure.
At this point it seems that it is likely that patients with stage 1, 2 and even stage 3 tumors can be cured with liver transplantation provided that the surveillance and detection of spread of the disease within the liver is accurate and confined at those early stages.
Stage 1: tumors are small and less than 2 centimeters with out any sign of blood vessel invasion.
Stage 2: tumors are also small but may have invasion into the microscopic veins in a liver
Where as Stage 3 lesions (tumors) are larger, up to several centimeters and occupy only one lobe but are still free from any invasion to the major veins in the liver a feature which can be seen in a CT scan.
Therefore it is usually possible to qualify a patient’s disease stage based on a pre-operative CT scan and in this matter the patients are stratified according to curable versus non-curable for transplantation. Any patient who is deemed curable in those first three stages, can then receive an exemption and extra points in the scheme of organ distribution.
For more information, please visit the USC Liver Transplant Program web site.
|