Liver Transplants for Cancer Patients
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Liver cancer is one of the most common causes of cancer death. The American Cancer Society estimates 26,190 new cases in the United States and 19,590 deaths for 2011. Liver transplantation is the preferred treatment for most patients.
Dr. Ali Zarrinpar and colleagues at the David Geffen School of Medicine at UCLA, Los Angeles, California, provided a review.
Hepatocellular carcinoma is the medical term for most cancers of the liver. “It arises almost exclusively from a background of cirrhosis,” Zarrinpar reported. Cirrhosis is scarring of the liver and poor liver function.
The U. S. National Library of Medicine's PubMed Health web site lists common causes as infection by hepatitis B or C, autoimmune disease, alcohol abuse, hereditary hemochromatosis, disorders of the biliary system, medications, and nonalcoholic fatty liver disease. The presence of moderate to severe cirrhosis rules out surgery to remove the tumor alone.
“Liver transplantation is the most beneficial oncologic treatment,” Zarrinpar explained. The Milan criteria for transplant candidates include one tumor of 5 cm diameter or less, or 2 to 3 tumors of 3 cm diameter or less. Patients who meet these criteria have demonstrated 5-year survival rates of at least 70 percent.
Zarrinpar suggested that the Milan criteria may be too restrictive. Other research groups have demonstrated comparable results with larger tumors and with up to 10 total tumors.
Preoperative treatment can reduce the size of the tumor(s) and improve survival. Options include percutaneous ethanol injection (PEI), percutaneous acetic acid injection (PAI), radiofrequency ablation, transarterial embolization, chemoembolization, and transarterial radioembolization. These are considered locoregional therapies, and they are also used in patients who are not surgical candidates.
Immunosuppression is necessary for all organ transplant recipients. This poses special problems for cancer patients who may have microscopic metastases. Early immunosuppresive regimens were found to increase the risk of cancer recurrence.
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