Liver transplantation in primary and secondary tumors of the liver. Review of the literature and perspectives

Liver transplantation for malignancies still remains a controversial issue. There is concern for tumour recurrence, poor results and waste of organs, which in the sitting of organ shortage would penalize patients with non-malignant disease. Many centers worldwide perform liver transplantation (OLT) for hepatocellular (HCC) carcinoma associated with liver cirrhosis; the results in these cases are similar to those of patients transplanted for other indications. On the contrary are very few the centers that perform OLT for tumour other than HCC. This reflects that tumours other than HCC are less common and survival is poor compared to patients transplanted for non-malignant disease. Acceptable indications for OLT in case of tumours other than HCC are liver metastases from neuroendocrine tumours and epithelioid emangio-endothelioma. However should be kept in mind that OLT may offer the sole opportunity to cure the tumour and the underlying disease in some patients while providing meaningful palliation for others. At the present the overall experience with OLT for tumours other than HCC is still not significant and the results are discouraging. There is no evidence that OLT is beneficial for non-HCC tumours. Hopefully for the next future new adjuvant and neoadjuvant therapies combined with OLT would provide improved survival. Nevertheless, long-term survivors continue to be reported suggesting that OLT may be beneficial in individual selected cases with non-HCC tumour.