Transplant for Liver Cancer

A liver transplant can replace a cancerous, diseased liver with a functional, healthy liver.

Hepatocellular carcinoma is the most common form of primary liver cancer.

This type of liver cancer usually has very few treatment options and a short-term survival rate.

For some people with hepatocellular carcinoma and cirrhosis of the liver, experts at WashU Medicine and Siteman Cancer Center offer liver transplant as a treatment option.

Why treat liver cancer with transplant?

Some people with hepatocellular carcinoma can be treated with surgical resection. This means removing the cancerous part of the liver. A healthy liver would be able to regenerate after removing part of the organ.

For people who have both hepatocellular carcinoma and a condition like cirrhosis, the liver would not be able to regenerate after removing the cancer, because of their liver disease.

A liver transplant can solve both problems—removing the cancerous tissue and replacing the diseased liver with a healthy organ.

Learn more about liver cancer>>

Causes

Liver cancer occurs due to the uncontrolled growth of abnormal cells in the liver.

Chronic liver diseases like hepatitis B or C, cirrhosis, and fatty liver disease, as well as excessive alcohol consumption significantly increase the risk.

Additionally, genetic factors, exposure to toxins and obesity are also contributing factors.

Screenings

Early detection is crucial for effective liver cancer management.

Regular screenings include blood tests measuring alpha-fetoprotein (AFP) levels and imaging tests like ultrasound, CT scans and MRIs.

Individuals with risk factors should discuss regular screening schedules with their health care provider.

Diagnosis

Diagnosis typically follows abnormal screening results.

To confirm liver cancer, doctors may perform a liver biopsy where a tissue sample is taken and analyzed.

Imaging studies like MRI and CT scans help determine the cancer’s size, location and whether it has spread (metastasized).

Types of treatment

• Surgical care: Partial hepatectomy, or removal of the cancerous part of the liver, is an option for patients whose cancer is confined to a small portion of the liver and have good liver function overall.
• Liver transplant: In cases where the cancer is limited but surgery is not feasible due to poor liver function, a liver transplant may be recommended. This involves replacing the diseased liver with a healthy donor liver.
• Ablation techniques: Non-surgical methods such as radiofrequency ablation use heat to destroy cancer cells. This is often an option for small tumors.
• Radiation therapy: This involves using high-energy rays to kill cancer cells and shrink tumors, often used when surgery isn’t viable.
• Targeted therapy and immunotherapy: Medications targeting specific genetic markers of the cancer or boosting the body’s immune response can be effective, particularly for advanced stages.

Listing for transplant

Once the evaluation confirms that a liver transplant is the best option, the patient is listed on the transplant waiting list.

The liver allocation system prioritizes patients based on their Model for End-Stage Liver Disease (MELD) score, which reflects the severity of liver disease.

Learn more about liver transplant>>

Medication

Medications are often used to manage symptoms and slow disease progression. These include targeted therapy drugs like sorafenib and immunotherapy drugs such as nivolumab. Pain management and anti-nausea drugs are also commonly prescribed to improve quality of life.

Liver cancer management while waiting for transplant

• Locoregional therapies: These therapies aim to control tumor growth and maintain the patient’s waitlist status:
• Radiofrequency ablation (RFA): Uses heat to destroy cancer cells.
• Transarterial chemoembolization (TACE): Delivers chemotherapy directly to the tumor while blocking its blood supply.
• Selective internal radiation therapy (SIRT): Involves injecting radioactive beads into the liver’s blood vessels to target tumors.
• Systemic therapies: Systemic therapies might be recommended based on the patient’s condition and tumor characteristics:
• Targeted therapy: Drugs like sorafenib that target specific cancer cell mechanisms.
• Immunotherapy: Medications such as nivolumab that help boost the immune system to fight cancer.
• Regular surveillance: Patients undergo regular imaging studies and blood tests to monitor tumor status and overall liver function. The frequency of these follow-ups is determined based on individual risk factors and clinical condition.

Potential complications

While liver cancer treatment can be lifesaving, it does carry potential complications such as infections, bleeding, organ rejection (in transplants), or side effects from medications like fatigue, skin rashes and gastrointestinal issues.

Health optimization

Maintaining overall health is crucial while waiting for a transplant. Our team provides guidance on:

• Diet and nutrition: Tailored nutritional plans to support liver health.
• Alcohol cessation: If applicable, counseling and support to stop alcohol consumption.
• Weight management: Strategies to achieve and maintain a healthy weight.
• Physical activity: Safe exercise programs to preserve muscle mass and physical strength.
• Mental health support: Psychological counseling to manage stress, anxiety and depression.

Learn more about getting ready for surgery>>

Getting ready for transplant

In preparation for transplant surgery, patients and their caregivers receive detailed education on what to expect before, during and after the procedure. This includes:

• Understanding the surgical process
• Learning about post-surgery care and medications
• Recognizing signs of complications and knowing when to seek help

Recovery

Recovery is a critical phase involving regular follow-ups to monitor for recurrence, managing side effects and maintaining liver health through appropriate lifestyle choices. This includes a balanced diet, avoiding alcohol, managing weight and taking prescribed medications diligently. Psychological and social support is also crucial during recovery and beyond.

Navigating liver cancer is undeniably challenging, but understanding the causes, available screening methods, diverse treatment options and the importance of recovery can help you make empowered decisions. Always consult with your health care team to create a personalized treatment plan tailored to your specific needs.