Ablative Therapies | Chemotherapy | IMRT | Liver Transplant | Resection
The current strategy in liver transplantation 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 without any sign of blood vessel invasion
- Stage 2: tumors are also small but may have invasion into the microscopic veins in a liver
- Stage 3: 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.
Live Donor Liver Transplantation
Live donor liver transplantation takes advantage of the liver's ability to immediately function and grow after transplantation from a living donor to an appropriate recipient. LDLT usually affords the patient with advanced liver disease an earlier opportunity for transplantation than allowed by more conventional liver transplantation from a deceased donor. Patients undergoing evaluation for receiving a living donor transplant must be candidates for cadaveric liver transplant.
Live donor liver transplantation may be a considered treatment option for certain patients with liver cancer. For selected patients, LDLT may represent the best chance for early cancer removal and cure.