Liver transplantation for malignant disease.

Recent progress has been made in identifying patients with malignant primary liver tumors who have the best chance of long-term survival after orthotopic liver transplantation. Patients with UICC stages I or II hepatocellular carcinoma, the fibrolamellar variant of hepatocellular carcinoma, or epithelioid hepatic hemangioendothelioma are acceptable candidates for orthotopic liver transplantation. Carefully selected patients with neuroendocrine tumors metastatic to the liver may also have long-term palliation with liver transplantation. Therapeutic strategies are currently being developed to minimize disease recurrence after liver transplantation for patients with advanced-stage hepatocellular carcinoma confined to the liver or with cholangiocarcinoma. However, published survival rates for most patients with malignant primary liver tumors remain suboptimal, and significant progress in preventing disease recurrence is required before liver transplantation can be widely applied to most patients with primary malignant liver tumors.