Transplantation for hepatocellular carcinoma

Liver transplantation (LT) is universally accepted as the final rescue therapy for endstage liver disease. Although there are a lot of primary diseases for the indication of LT, hepatocellular carcinoma (HCC) is one of the major indications of LT. In this chapter, LT is described on the basis of two different backgrounds i.e. Japan and western countries, and this contrast represents the living donor and the deceased donor transplantation. Milan criteria has been the gold standard criteria for HCC, but expanding the criteria has been proposed by some authors in light of favorable results noted in single center studies with variable durations of follow-up. The question still remains whether resection and LT should be considered as alternative, complimentary, or sequential in an intention-to-treat strategy. Immunosuppressants and chemotherapies on LT still remain controversial. The future direction of determining optimal LT for an individual patient requires consideration of numerous factors including liver damage, tumor stage, biomarkers, imaging techniques, and geographical transplant availability.