For some individuals with liver cancer, a liver transplant offers a potentially life-extending treatment. This procedure replaces a diseased liver with a healthy one, addressing both the cancer and underlying liver disease. Understanding eligibility, potential outcomes, and life after transplant is crucial to determine if it can truly cure liver cancer.
Understanding Liver Cancer and Transplant
Liver cancer can originate in the liver itself, known as primary liver cancer, or spread from other parts of the body (metastatic). The most common primary type is hepatocellular carcinoma (HCC), often developing with chronic liver diseases like cirrhosis. Liver transplants are typically considered for primary liver cancer confined to the organ.
A liver transplant involves removing the diseased liver and replacing it with a healthy one from a deceased donor, or a segment from a living donor. The liver’s ability to regenerate allows a donated segment to grow back to normal size within months.
Eligibility for Transplant in Cancer Cases
Strict criteria determine if a liver cancer patient is eligible for a transplant, primarily to maximize success and minimize recurrence. The most widely recognized guidelines are the Milan criteria, which specify a single tumor no larger than 5 centimeters, or up to three tumors each no larger than 3 centimeters. These criteria also require no evidence of vascular invasion or cancer spread outside the liver. Adherence to these guidelines has improved post-transplant outcomes for HCC patients.
Other expanded criteria, such as the UCSF criteria, allow for slightly larger or more numerous tumors. Patients whose tumors initially exceed these limits may undergo “downstaging” therapies, like chemoembolization or radiofrequency ablation, to shrink the tumors to within transplantable size. Beyond tumor characteristics, candidates must meet general health requirements and navigate the limited availability of donor organs, which often leads to long waiting lists.
Transplant Outcomes and Cancer Recurrence
For liver cancer, “cure” generally refers to long-term remission or disease-free survival. Liver transplantation offers a significant chance for this outcome. For patients meeting the Milan criteria, 5-year survival rates after transplant are typically between 70% and 75%, comparable to survival rates for transplants performed for non-cancerous liver diseases.
Despite these favorable outcomes, cancer recurrence remains a possibility, occurring in approximately 8% to 20% of patients following a liver transplant for HCC. Several factors influence this risk, including the presence of vascular invasion by the tumor, the tumor’s differentiation grade, and elevated alpha-fetoprotein (AFP) levels before transplant. Most recurrences are diagnosed within the first two years post-transplant. Regular monitoring with imaging and blood tests helps detect any signs of recurrence early.
Life After Liver Transplant
Life after a liver transplant involves a lifelong commitment to medical management and lifestyle adjustments. Patients must take immunosuppressive medications daily to prevent the body’s immune system from rejecting the new organ. These medications can increase the risk of infections and may have side effects such as kidney impairment or high blood pressure. The dosage may be adjusted over time, but some form of immunosuppression is always necessary.
Regular medical follow-ups are crucial to monitor the new liver’s function, adjust medications, and screen for potential complications or cancer recurrence. Patients are advised to adopt healthy lifestyle habits, including a balanced diet and regular physical activity as tolerated. Avoiding alcohol is imperative, and protecting the skin from sun exposure is important due to an increased risk of skin cancers with immunosuppression.