When Primary Liver Cancer should be Transplanted?? Part 1

We have dicussed about liver resection in case of primary liver cancer and limitation due to underlying liver disease.

So when should primary liver cancer transplanted??

Idea behind liver transplantation for hepatocellular carcinoma is that it is believed that hepatocellular carcinoma or primary liver cancer most commonly occurs due to underlying liver disease.So if diseased liver is changed with healthy liver before liver cancer is spread to any other part of the body chances of recurrence of cancer are low.

However for transplantation some one has to donate. This donated liver comes from either brain dead donor and living donor.

Brain dead donations are believed to be gift to the society so it is given to the patient who is most benefitted from the transplantation. Because lots of patients who have end stage liver disease but not liver cancer are also wating for special gift called organ.

So After years of research scientists have concluded that patients are most benefited from transplant if tumor burden is not exceeding a certain limit.

So they defined crteria. If patients fulfills that criteria than he is suitable for transplantaion.

There are mainly two criteria accepted around the world for liver transplantation.

·      Milan criteria :

o   One lesion smaller than 5 cm

o   Up to 3 lesion with each lesion smaller than 3 cm

o   No spread outside liver

o   No liver blood vessel involvement

·      University of california San Fransisco criteria or UCSF criteria.

o   No Single lesion greater than 6.5 cm

o   Up to 3 lesion none greater than 4.5 cm

o   Totoal tumor size should not be more than 8 cm

Reason for defining these criteria is that it shown that if size and number and liver cancer increase there is increase chance of early recurrence of the cancer and that means whole activitiy of transplant becomes futile and one prescious gift to society (donated liver) is wasted.

And if we can transplant the disesed liver with HCC within these criteria then chances of cure of liver cancer are increased dramatically with more than 70-80% of the patients live more than 5 years.

Brain death liver transplantation

How underlying disease can lead to primary liver cancer??

Living donation is the personal gift as donor is giving his organ to a particular person and not to the society so there is dilema weather to stic to these criteria in living donation or not. That  I will discuss in part 2.