Which malignancies are associated with whole-liver orthotopic liver transplantation (OLTX)?

Updated: Nov 11, 2019
  • Author: Fazal Hussain, MD, MPH; Chief Editor: John Karani, MBBS, FRCR  more...
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Immunosuppressive therapy to prevent rejection is requisite after liver transplantation. However, the treatment is associated with an increased risk of malignancy in the recipient. [38] Of the neoplasms that also occur in immunocompetent individuals, skin and cervical carcinomas are more likely to occur in transplantation patients.

Immunocompromised hepatic allograft recipients are at risk for posttransplantation lymphoproliferative disease (PTLD). Approximately 1-2% of patients receiving livers develop PTLD. Low-dose and steroid-free regimens probably reduce the frequency of PTLD.

Some orthotopic liver transplantations (OLTXs) are performed in patients with known hepatobiliary malignancy or in persons at high risk for it. Patients with hepatocellular carcinoma (HCC) are candidates for OLTX if the disease is unilobar and if no lesion exceeds 5 cm in diameter. [23]

In patients who develop recurrent or metastatic HCC after OLTX, 46% have metastases in the allograft. Other sites of metastatic disease include the lungs, regional lymph nodes, adrenal glands, and bones. Patients with primary sclerosing cholangitis (PSC) and cirrhosis are commonly considered candidates for liver transplantation. [22]

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