Liver transplantation for unresectable hepatocellular carcinoma in normal livers

Hynek Mergental, Rene Adam, Bo Goran Ericzon, Piotr Kalicinski, Ferninand Mühlbacher, Krister Höckerstedt, Jürgen L. Klempnauer, Styrbjörn Friman, Christoph E. Broelsch, Georges Mantion, Carlos Fernandez-Sellez, Bart Van Hoek, Josef Fangmann, Jacques Pirenne, Paolo Muiesan, Alfred Königsrainer, Darius F. Mirza, Jan Lerut, Olivier Detry, Yves Ptrice Le TreutVincenzo Mazzaferro, Florian Löhe, Marina Berenguer, Pierre Alain Clavien, Xavier Rogiers, Jacques Belghiti, Laslo Kóbori, Patrizia Burra, Philippe Wolf, Wolfgang Schareck, Przemyslaw Pisarski, Aksel Foss, Franco Filipponi, Marek Krawczyk, Martin Wolff, Jan M. Langrehr, Keith Rolles, Neville Jamieson, Wim C.J. Hop, Robert J. Porte

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29 Citations (Scopus)


Background & Aims: The role of liver transplantation in the treatment of hepatocellular carcinoma in livers without fibrosis/cirrhosis (NC-HCC) is unclear. We aimed to determine selection criteria for liver transplantation in patients with NC-HCC. Methods: Using the European Liver Transplant Registry, we identified 105 patients who underwent liver transplantation for unresectable NC-HCC. Detailed information about patient, tumor characteristics, and survival was obtained from the transplant centers. Variables associated with survival were identified using univariate and multivariate statistical analyses. Results: Liver transplantation was primary treatment in 62 patients and rescue therapy for intrahepatic recurrences after liver resection in 43. Median number of tumors was 3 (range 1-7) and median tumor size 8 cm (range 0.5-30). One- and 5-year overall and tumor-free survival rates were 84% and 49% and 76% and 43%, respectively. Macrovascular invasion (HR 2.55, 95% CI 1.34 to 4.86), lymph node involvement (HR 2.60, 95% CI 1.28 to 5.28), and time interval between liver resection and transplantation <12 months (HR 2.12, 95% CI 0.96 to 4.67) were independently associated with survival. Five-year survival in patients without macrovascular invasion or lymph node involvement was 59% (95% CI 47-70%). Tumor size was not associated with survival. Conclusions: This is the largest reported series of patients transplanted for NC-HCC. Selection of patients without macrovascular invasion or lymph node involvement, or patients ≥12 months after previous liver resection, can result in 5-year survival rates of 59%. In contrast to HCC in cirrhosis, tumor size is not a predictor of post-transplant survival in NC-HCC.

Original languageEnglish
Pages (from-to)297-305
Number of pages9
JournalJournal of Hepatology
Issue number2
Publication statusPublished - Aug 1 2012



  • Hepatocellular carcinoma
  • Hepatoma
  • Liver transplantation
  • Non-cirrhotic
  • Non-fibrotic
  • Recurrent
  • Unresectable

ASJC Scopus subject areas

  • Hepatology

Cite this

Mergental, H., Adam, R., Ericzon, B. G., Kalicinski, P., Mühlbacher, F., Höckerstedt, K., Klempnauer, J. L., Friman, S., Broelsch, C. E., Mantion, G., Fernandez-Sellez, C., Van Hoek, B., Fangmann, J., Pirenne, J., Muiesan, P., Königsrainer, A., Mirza, D. F., Lerut, J., Detry, O., ... Porte, R. J. (2012). Liver transplantation for unresectable hepatocellular carcinoma in normal livers. Journal of Hepatology, 57(2), 297-305.