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Table 4. Liver transplants in Latin America and the Caribbean in 2016
Country Number of transplants PMP Waiting list*
Argentina 368 8.4 2008
Bolivia 1 0.1 4
Brazil 1880 9.0 4673
Chile 93 5.1 256
Colombia 240 4.9 74
Costa Rica 13 2.7 60
Cuba 20 1.8 32
Dominican Republic 3 0.3 20
Ecuador 31 1.9 34
El Salvador - - -
Guatemala 0 0.0 -
Mexico 178 1.4 681
Peru 23 0.7 40
Puerto Rico 42 12.0 32
Venezuela 2 < 0.1 19
*Total number of patients who were active on the waiting list in 2016; -data not found. PMP: per million population

THERAPY
The Latin America Association for the Study of the Liver (ALEH) published the clinical guidelines for the
management of HCC in the region. The ALEH indicates the staging procedures that should be carried out.
Also, one of its main objectives is to define the best therapeutic strategy for each patient. The most widely
used staging system is the Barcelona Clinic Liver Cancer (BCLC) system since it relates each stage of HCC
with the most appropriate treatment according to scientific evidence [5,66] . Generally, HCC can be approached
by curative or systemic treatments. Curative treatment is possible if HCC is diagnosed at an early stage.

Curative treatment
According to the BCLC classification, three curative treatments are available: liver resection, liver
[67]
transplantation, and local ablation .

Liver resection is the best therapeutic option for HCC patients with or without cirrhosis, when the liver is
[18]
still functional . The aim of this surgical procedure is to obtain at least 2 cm margins through anatomic
resection, except when the cirrhotic patient’s healthy residual liver is compromised [70-73] . Liver resection and
liver transplantation are the only curative treatments for HCC patients, but unfortunately only 5% to 10%
[68]
of patients are candidates because most have advanced disease and poor liver function . This option has
[69]
shown good results with up to 60% 5-year survival and low perioperative mortality (0.8%-3%) . If liver
transplantation is contraindicated, the alternative is locoregional therapy. To select the ideal candidate, CT
[5]
or MR evaluation of tumor size, presence of satellite lesions and vascular involvement are very important .
In some Latin American regions, HCC resection is recommended in patients classified as intermediate stage,
when the liver has not completely lost its function, and survival of 5 years can still be achieved (patients with
Child-Pugh A) [66,74] .

Liver transplantation is the best option for treatment taking into account the tumor and the concomitant
[18]
disease. In Latin America, the main problem is the absence of a organ donation culture . Liver resection
and transplantation are curative surgical treatments for HCC by removing both the tumor and cirrhosis. It is
important then, to considerer: (1) the candidate according to their tumor stage, liver function, physiological
[75]
status, (2) the experience of the medical staff performing the surgery . BCLC guidelines are the most
[77]
[76]
widely accepted for assessing a HCC patient’s prognosis . According to Mazzaferro et al. , a patient could
be eligible for liver transplantation when its expected survival is at least 70% at 5 years; this survival also
depends of lesions size. In Mexico, liver transplantation is the first choice treatment for patients with Child-