Candidates for
liver transplantation (OLT) may be found to have an incidental extrahepatic
tumor, which is amenable to resection, and may be associated with variable long-term survival. Issues to be considered include: (1) Whether it is possible to define a
tumor stage and survival expectancy, which makes the patient an acceptable transplant candidate; (2) Whether
cancer surgery should be preformed prior, during, or after OLT; (3) Whether the recipient be placed on immunosuppression that is tailored to address concern related to
cancer recurrence. These issues are illustrated in the context of OLT and
nephrectomy for
renal cell carcinoma (RCC). Two patients underwent a simultaneous OLT and curative radical
nephrectomy for stage 1 RCC that was incidentally discovered during OLT evaluation, one of whom received a simultaneous kidney transplant. At 51 and 14 months postoperatively, the patients are alive and healthy, with no
tumor recurrence. In selected extrahepatic
malignancies, simultaneous curative resection and OLT may provide the optimal outcome. This is justifiable when curative
cancer-related life expectancy exceeds OLT-expected graft and patient survival. Concomitant
transplantation and
cancer surgery provides an acceptable
cancer-free survival, avoiding the high morbidity observed when
cancer resection is done in the presence of decompensated
liver disease.