Liver organ allocation for hepatocellular carcinoma: are we sure?

Of patients with hepatocellular carcinoma (HCC), 70% to 90% present with cirrhosis. Accordingly, liver transplantation (LT), not liver resection, currently remains the only possibility of cure for these patients. Because there is a severe shortage of liver organ donors, not all patients in need can be offered LT. Therefore, transplant listing criteria simultaneously must determine the greatest number of suitable candidates for transplantation while rejecting the smallest number of those who could benefit from LT. The objective of this study was to determine the outcome of patients with HCC who are denied LT by current listing criteria. Of patients who are being denied liver transplantation by the current United Network for Organ Sharing listing criteria (but who were transplanted before the current guidelines took effect), 27% to 49% were cured by this procedure. The listing criteria for LT in the presence of HCC should reflect the minimum acceptable (not maximum acceptable) recurrence-free survival rate and must reflect a consensus of the transplant community.