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Salvage Transplantation: Does Saving Livers Save Lives?

Liver transplantation remains the most effective treatment for patients with both hepatocellular carcinoma that are within Milan criteria (HCC) and cirrhosis, including those with well-compensated cirrhosis. Numerous studies over the past decade have documented patient survival rates greater than 75% at 4 years with HCC recurrence rates of less than 10%, which compares favorably with all other forms of treatment including liver resection (1). As a result liver transplantation is often considered to be the treatment of choice for many patients. Limited availability of donor livers has resulted in prolonged waiting times with the potential for tumor progression and subsequent ‘drop out’ from the waiting list. For many patients, in the absence of HCC, progressive liver disease with decompensation may be years away. For these reasons many programs have proposed liver resection as the primary treatment for patients followed by salvage transplantation in the event of HCC recurrence or liver failure.