Liver transplantation for liver cancer

Results in the first 100 orthotopic liver allografts performed in the Cambridge‐King's College Hospital series (1968–1980) are reported. Twenty‐two patients survived beyond a year (age range, 16–59 years). Of these, 12 were cirrhotics and 10 were primary malignancies. Of the cirrhotics, 10 are alive, with the 2 deaths resulting from cholangitis. Two patients who had primary hepatic carcinoma are alive at 1 and 5 years following transplantation; the 8 deaths in this group were attributed to tumor recurrence (5 patients), sepsis (2 patients), and secondary cirrhosis possibly due to non‐A non‐B hepatitis (1 patient). Patients who survive for 6 months have a greatly increased chance of surviving the second 6 months and subsequently. Of the last 14 liver allografts (12 for cirrhosis and 2 for primary malignancy), there are 9 survivors. This mortality (36%) probably represents the results of better selection of the cirrhotics before they were too sick to withstand the operation; better control of rejection; and refinements in surgical procedure and anesthesia. For those patients surviving the first year, there is a 40% chance of the tumor's being eliminated. The late tumor recurrence rate is unacceptably high at 60%, however, and our criteria for patient selection have become increasingly selective.