Individualized curative treatment for malignant diseases through liver transplantation

• Published in: Chirurgie (Heidelberg, Germany) Vol. 95; no. 2; pp. 122 - 128
• Main Authors: Schwenk, Laura, Rauchfuß, Falk, Ali-Deeb, Aladdin, Dondorf, Felix, Rohland, Oliver, Ardelt, Michael, Settmacher, Utz
• Format: Journal Article
• Language: German
• Published: Germany 01.02.2024
• Subjects: Bile Duct Neoplasms - surgery; Bile Ducts, Intrahepatic - surgery; Carcinoma, Hepatocellular - surgery; Humans; Liver Neoplasms - pathology; Liver Neoplasms - surgery; Liver Transplantation; Living Donors; Treatment Outcome; Neoadjuvant therapy; Allocation criteria; Nonresectable liver tumors; Living donors; Primary and metastatic liver tumors
• ISSN: 2731-698X
• DOI: 10.1007/s00104-023-01973-z

For patients with primary and secondary liver tumors that are functionally or technically nonresectable, liver transplantation remains the sole curative treatment option. Over the years the benefits of transplantation have also been validated for conditions other than hepatocellular carcinoma. Currently, amidst a period of organ shortage the broadening of transplantation indications is a topic of ongoing debate. Although recent studies have confirmed the long-term success of transplantation within multimodal treatment regimens, this approach has yet to become the standard treatment for many conditions. This article explores the potential of liver transplantation in individualized multimodal oncological treatment strategies. Liver transplantation has become an integral component of the treatment regimen for hepatocellular carcinoma. In Germany there is a prioritized organ allocation facilitated by the granting of a standard exception for cases with a smaller tumor burden. Over the years numerous studies have demonstrated comparable long-term results using different listing criteria. Both intrahepatic cholangiocarcinoma and perihilar cholangiocarcinoma can be curatively treated with transplantation in Germany, although this is typically within the context of clinical studies. The neoadjuvant therapy and patient selection, based on tumor burden and the response to preliminary treatment, play a crucial role in influencing long-term survival and recurrence rates. The success of transplantation for liver metastases from neuroendocrine malignancies or colorectal carcinomas, which cannot be removed by partial resection, also significantly hinges on the patient selection. The role of living donor liver transplantation is becoming increasingly more pivotal in this context.