Liver transplant for those who suffer from cirrhosis with cancer(HCC) is still controversial. While there are some international guidelines for liver transplantation for HCC, there are many who fall beyond the criteria advocated. Quite often the decision to transplant these patients are emotional than scientific. Majority should be transplanted for liver filure and not for presence of cancer. Staging and evaluating the biology of HCC is still rudimentary. There are few predictors or markers that can be relied on and even those which indicate the presence of HCC, seldom indicate the stage of progression of the cancer. If there is any extrahepatic disease that goes undetected at the time of transplant, the recurrence is hastened and the survival is shortened dramatically. The best strategy for all patients is not to rush for a transplant. Go for various cancer treatment options, down stage the disease and watch for 3 months or more to select those with good tumour biology. This will help to cure with transplant than hasten their demise!
