Liver transplantation for hepatocellular carcinoma in cirrhosis within the eurotransplant area:: An additional option with "Livers that nobody wants"

Background. Liver transplantation is recognized as the treatment of choice for small hepatocellular carcinomas (HCC) in patients with end-stage liver failure. However, because of limited organ availability, not all those who qualify can benefit from it. Methods. Over a 3-year period, we accepted and subsequently transplanted 10 deceased donor liver allografts allocated through Eurotransplant. These organs had been officially offered to and rejected by other transplant centers a total of 40 times due to medical or logistical reasons prior to our acceptance. They were implanted into patients in the waiting list with HCC and cirrhosis. Recipients without HCC transplanted with such "undesirable" grafts were not included in this study. Results. Two patients had initial poor graft function but subsequently recovered. There was one arterial complication requiring reintervention. Median intensive care unit and hospital stays were 6 and 28 days respectively. One patient developed renal insufficiency, but recovered after 3 months. One patient developed HCC recurrence in the allograft and underwent a successful atypical liver resection 23 months after transplantation. All patients are currently alive, with follow-up periods ranging from 5 to 36 months. Conclusions. Liver transplantation with such "livers that nobody wants" constitutes an additional option for patients with HCC and cirrhosis. The risk-benefit ratio in these instances should be evaluated on a case-by-case basis.