Ask the Experts - Liver Transplantation in Foreign Nationals With...
I am a practicing gastroenterologist in Cebu City, Philippines. Liver cancer is one of the most common malignancies I see in my area. Can you tell me where in the United States liver transplantation for hepatocellular carcinoma (HCC) is performed and what is required of patients if they do opt for this treament?

Judy Lao-Tan, MD

In the United States, foreign national patients are allowed to be considered for liver transplantation, although there is a 5% maximum rule that applies, ie, foreign nationals cannot comprise more than 5% of a transplant center's transplanted patient volume. With respect to the issue of HCC, liver transplantation can be considered for those with end-stage liver disease who have small HCC tumors without vascular invasion (ie, the veins do not have thrombosis). The outcomes for liver transplantation in patients with such tumors is good; it is very similar to those in patients with HCC who are transplanted. However, the outcome for patients with more advanced tumor is poor. Therefore, the consideration for liver transplantation is based on the staging of the disease.

With regard to liver transplantation in the Philippines, there is an active program in Manila (Quezon City). The director is Dr. Carlo Ramirez; he can be reached at the National Kidney and Transplant Institute.