University Health Network, Toronto General Hospital, Department of Surgery, University of Toronto, 585 University Avenue, 11-PMB-184, Toronto Ontario M5G2N2, Canada.
Barcelona Clinic Liver Cancer group, Liver Unit, Hospital Clinic, University of Barcelona, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Villaroel 170, Barcelona 08036, Spain.
Nat Rev Gastroenterol Hepatol. 2017 Apr;14(4):203-217. doi: 10.1038/nrgastro.2016.193. Epub 2017 Jan 5.
Liver transplantation for hepatocellular carcinoma (HCC) is the best treatment option for patients with early-stage tumours and accounts for ∼20-40% of all liver transplantations performed at most centres worldwide. The Milan criteria are the most common criteria to select patients with HCC for transplantation but they can be seen as too restrictive. Several proposals have been made for a moderate expansion of the criteria, which result in good outcomes but with an increase in the risk of tumour recurrence. In this Review, we provide a comprehensive overview of the outcomes after liver transplantation for HCC, focusing on tumour recurrence in terms of surveillance, prevention and treatment. Additionally, novel surgical techniques have been developed to increase the available pool of organs for liver transplantation (such as living donor liver transplantation, donation after circulatory death and split livers), but the effect of these techniques on patients with HCC is still under debate. Thus, we will describe these techniques and expose the benefits and disadvantages of each surgical approach. Finally, we will comment on the limitations of the current priority policies for liver transplantation and the need to further refine them to better serve the population.
肝移植是治疗早期肝癌（HCC）的最佳选择，约占全球大多数中心进行的所有肝移植的 20-40%。米兰标准是选择 HCC 患者进行移植的最常用标准，但它们可能被认为过于严格。已经提出了一些适度扩大标准的建议，这些建议可以带来良好的结果，但肿瘤复发的风险增加。在这篇综述中，我们全面概述了 HCC 肝移植后的结果，重点关注肿瘤复发的监测、预防和治疗。此外，还开发了新的手术技术来增加可用于肝移植的器官供应（如活体供肝移植、循环死亡后捐献和劈裂肝），但这些技术对 HCC 患者的影响仍存在争议。因此，我们将描述这些技术，并介绍每种手术方法的优缺点。最后，我们将评论当前肝移植优先政策的局限性以及需要进一步完善这些政策以更好地为人群服务的必要性。
