Liver transplantation is a leading treatment option for certain types of liver cancer. This procedure involves replacing a damaged liver with a healthy one from a donor. Patients with liver cancer confined to the liver and who have not responded well to traditional treatments might benefit significantly from a transplant. Success depends on several factors, including the cancer stage, the patient’s overall health, and the availability of a suitable donor liver.
This blog provides an in-depth look at the liver cancer types that may warrant a liver transplant. By understanding the criteria for liver transplantation, patients and their families can make informed decisions about their treatment options.
Hepatocellular Carcinoma (HCC)
Hepatocellular carcinoma (HCC) is the most prevalent form of primary liver cancer, accounting for about 75% of cases. It typically develops from chronic liver conditions like cirrhosis, often due to alcohol use, non-alcoholic fatty liver disease, or hepatitis B or C infections.
HCC generally progresses slowly, with symptoms such as weight loss, fatigue, jaundice, and abdominal discomfort becoming noticeable only in advanced stages. Early diagnosis and treatment are crucial but challenging due to the late onset of symptoms.
Eligibility Criteria for Liver Transplant in HCC Patients
To achieve optimal outcomes, several criteria have been established for liver transplantation in HCC patients:
- Milan Criteria:
- Single Tumor: Up to 5 centimeters in diameter.
- Multiple Tumors: Up to three tumors, each no larger than 3 centimeters.
- UCSF Criteria:
- Single Tumor: Up to 6.5 centimeters in diameter.
- Multiple Tumors: Up to three tumors, none larger than 4.5 centimeters, with a total tumor diameter not exceeding 8 centimeters.
There are various other criteria developed at reputed institutes around the world with good short and long-term success. Tumours beyond the above-mentioned criteria are not a straightaway contraindication for liver transplant unless there is vascular or extrahepatic spread. Moreover, even these extensive tumours can be downstaged with various modalities and be brought under the transplantation criteria and extending survival benefit with liver transplant.
Additional criteria include:
- Absence of Vascular Invasion: No invasion into blood vessels within the liver.
- No Extrahepatic Spread: Cancer must not have spread to other organs.
- General Health Status: The patient should be in overall good health to withstand surgery and post-operative care.
- Response to Bridging Therapy: Evaluation of response to pre-transplant treatments like radiofrequency ablation or transarterial chemoembolization (TACE).
Meeting these criteria ensures that the liver transplant is likely to result in a successful outcome and improved long-term survival.
Benefits of Liver Transplants for HCC Patients
Liver transplants offer significant advantages for HCC patients. Research shows that those meeting the Milan criteria have about a 70% 5-year survival rate. The transplant removes the malignant tissue and replaces the damaged liver, halting chronic liver disease progression and reducing the risk of new tumors, which leads to better long-term health outcomes.
Cholangiocarcinoma (Bile Duct Cancer)
Liver transplantation may be an option for cholangiocarcinoma (bile duct cancer) under certain conditions, particularly when the cancer is localized to the liver and bile ducts. Cholangiocarcinoma is rare and aggressive, making careful patient selection and evaluation essential for success.
Eligibility Criteria for Liver Transplant in Cholangiocarcinoma Patients
- Tumor Localization: Cancer must be confined to the liver and bile ducts, without distant metastasis.
- Tumor Size and Number: Criteria for size and number often follow principles similar to those for HCC:
- Single Tumor or Limited Number of Tumors: Tumors must be manageable surgically.
- Size and Number: Acceptable limits vary by transplant center.
- Absence of Vascular Invasion: No invasion of major blood vessels within the liver.
- No Extrahepatic Spread: Cancer must not have spread to other organs or distant lymph nodes.
- Surgical Resectability: Tumors should be surgically resectable with a high likelihood of recurrence.
- Overall Health: The patient should be in good overall health.
- Response to Neoadjuvant Therapy: Response to pre-transplant treatments like chemotherapy or radiation may be considered.
- Challenges with Cholangiocarcinoma: Given its aggressiveness and high recurrence rate, managing cholangiocarcinoma post-transplant presents significant challenges. Despite these, liver transplantation remains a critical treatment option, offering potential for extended survival and improved quality of life.
Metastatic Liver Cancer
Metastatic liver cancer occurs when cancer spreads to the liver from another body part. It is usually advanced, and treatment can be challenging. In some instances, if the cancer is confined to the liver and the primary tumor is controlled or removed, a liver transplant might be considered. Strict criteria and thorough evaluation are essential. While survival rates for metastatic liver cancer transplants are generally lower than for primary liver cancers like HCC, a liver transplant might still be viable if the cancer is restricted to the liver.
Liver Transplants with Liver Transplant India
A liver transplant is a major procedure that requires significant lifestyle changes. At Liver Transplant India, patient education is a priority. Dr. Soin and his team provide comprehensive support before, during, and after your liver transplant. They assess whether a liver transplant is the right option for you, considering numerous factors to ensure a coordinated care plan. Collaboration with your oncology team helps address all questions and make the transplant process as smooth as possible.
Conclusion
Liver transplants can be highly effective for various liver cancers, including HCC, cholangiocarcinoma, and metastatic cancer. Patients should consult medical specialists to receive personalized treatment plans. Liver transplants offer hope for improved survival rates and a better quality of life for those with liver cancer.
