For individuals with early liver cancer, especially when accompanied by severe cirrhosis, doctors often advise a liver transplant. A transplant is usually recommended for liver cancer patients who have 1 tumour which is up to 5cm in diameter, or 2 to 3 tumours, each less than 3cm in diameter. Some newer extended criteria’s are also showing very promising results of liver transplant. When the cancer has spread to other parts of the body, a transplant is off the table. Liver Transplant in background of cirrhosis, not only treats liver cancer, but it also removes the complications associated with the cirrhotic liver.

Patients undergoing a liver transplant have a 90% chance of surviving after an year, 75% chance of surviving 5 years and almost 60% chance of surviving 10 years, thanks to improved surgical techniques, intensive care and medications. On the flip side, without a liver transplant, liver cancer or advanced liver cirrhosis patients have a high chance of succumbing to their liver disease within 1 to 2 years.

There are some newer treatment options like Radiofrequency ablation (RFA) or Microwave ablation (MWA) that burns the liver cancers. There are also newer radiological procedures like TACE (where antitumour drugs are directly injected in the blood vessel supplying the cancer) /TARE (where radioactive particles are directly injected in the blood vessel supplying the cancer) that helps downstage or downsizevyour liver cancers before Liver Transplant.

The surgical procedure entails removing the diseased liver and replacing it with a new one. The liver can come from someone who has passed away recently, or from a living donor who provides a portion of the organ. Liver transplants are performed by a team of experts at the Narayana RN Tagore Hospital, Mukundapur.

Who are eligible for a liver transplant for liver cancer?

A liver transplant could be an option for those with liver cancer who have small tumours that haven’t grown into nearby blood vessels. (Size specifications mentioned above).
TACE/TARE also can downsize or downstage liver cancer before liver transplant.
To determine if you are eligible, an assessment is conducted to determine the health of your liver and whether a transplant is feasible. This includes liver function tests and a contrast MRI/CT or a PET CT scan. Every cirrhosis patient should check AFP (Blood Test) every 3 - 6 monthly to assess for development of cancer.
A partial hepatectomy is also possible, especially for those whose liver functions are not that bad and the cancer confined to a single lobe of liver (either left or right lobe).

Preparing for liver transplant

Living donors: If your liver is coming from a living donor, the transplant team will schedule the surgeries after proper evaluation of the donor with blood tests, CT scan or a MRCP. You and your donor will be given specific instructions on how to prepare for surgery.
Deceased donor transplant: You need to register yourself in NOTTO site after your doctor recommends for a liver transplant through your hospital and transplant coordinator will help you in this process. When a blood group matched cadaveric donor is found, you will be asked to rush to the hospital/transplant centre, so that the surgery can begin as soon as the recipient and the liver have both reached the centre. You should have your bag packed and other arrangements in place, and on high alert.

The procedure

The surgeon makes a large cut in your upper abdomen, removes the diseased liver and replaces it with a healthy liver or portion of liver. The replacement liver is attached to your bile ducts and blood vessels. It’s a complex surgery which can take up to 10- 12 hours.

Post-surgery –

Follow up AFP level every 3 months and a PET CT scan at 6 months post-surgery. Immunosuppressant medicines should be continued. Some newer immunosuppressive medicines also help in preventing recurrence of the cancer.