ABSTRACT
Surgery has remained the primary treatment for hepatocellular cancer (HCC) for over 50 years. However, since underlying cirrhosis, particularly cirrhosis caused by viral disease, is frequently associated with HCC, surgical resection is often limited by a lack of hepatic reserve and complications of portal hypertension. Thus, in most cases surgery can be applied to fewer than 25% of cases (1). It is for this reason that pioneering liver transplant surgeons began exploring the use of liver transplantation (LT) as the treatment for HCC in the late 1960s. The transplant option had several theoretical advantages because (i) it offered the potential to completely excise large tumors with adequate margin without being limited by tumor proximity to vital vascular or biliary structures, (ii) it replaced the diseased liver, thereby eliminating the need to leave adequate hepatic reserve, and (iii) it removed the entire liver, which otherwise would remain at risk for malignant transformation after partial hepatic resections. However, early results reported by groups from Germany (2), France (3), and the United States (4) and others were not encouraging as recurrence rates were very high. These initial dismal results discouraged transplant programs from pursuing LT for HCC for several years.
