Living donor liver transplantation for hepatocellular carcinoma achieves better outcomes

Hepatocellular carcinoma (HCC) is the fifth most common and the third causes of cancer-related mortalities. HCC is closely associated with chronic liver disease and as many as 80% of cases occur in cirrhotic livers. Although liver resection and local ablation are regarded as potentially curative treatments, the limited functional reserve of the liver restricts their application and there is a high chance of recurrence in the liver remnant (1). Liver transplantation (LT) is the only treatment that offers a chance of cure for the tumor and the underlying cirrhosis by complete extirpation of both. The outcome of LT for early HCC is encouraging, but the limitation of organ supply remains the main issue (2). In Asia, living donor LT (LDLT) has been emerging as the solution of organ shortage to treat HCC. At Kaohsiung Chang Gung Memorial Hospital, the first case of LDLT was performed for a pediatric patient with biliary atresia in 1994, and progressed to adult LDLT in 1999 (3). In the high endemicity of hepatitis B and C (HBV and HCV), HCC has become the most indication for LT. In this review, we summarize the experience of treating HCC in LDLT and current selection criteria, adjusted by our previous experience. Finally, we propose an algorithm of patient selection for HCC in LDLT to achieve better outcomes