Liver Transplant Oncology: Towards Dynamic Tumor-Biology-Oriented Patient Selection

Abstract

While liver transplantation was initially considered as a curative treatment modality only for hepatocellular carcinoma, the indication has been increasingly extended to other tumor entities over recent years, most recently to the treatment of non-resectable colorectal liver metastases. Although oncologic outcomes after liver transplantation (LT) are consistently good, organ shortage forces stringent selection of suitable candidates. Dynamic criteria based on tumor biology fulfill the prerequisite of an individual oncological prediction better than traditional morphometric criteria based on tumor burden. The availability of specific (neo-)adjuvant therapies and customized modern immunosuppression may further contribute to favorable post-transplantation outcomes on the one hand and simultaneously open the path to LT as a curative option for advanced stages of tumor patients. Herein, we provide an overview of the oncological LT indications, the selection process, and expected oncological outcome after LT.

Transplant oncology – Current indications and strategies to advance the field

“…This has led to the development of new patient selection criteria with the focus shifting from static, morphologic selection criteria towards more dynamic criteria, which better allow for the assessment of a tumour’s biologic behaviour over time. [24] , [25] , [26] , [27] With the important role of tumour biology in the setting of transplant oncology more clearly defined, interest in oncologic indications other than HCC such as cholangiocarcinoma (CCA), neuroendocrine tumours with liver metastases (NETLMs) 5 and CRLMs has resurfaced. 28 Factors fuelling the renewed interest in transplant oncology are presented in Fig.…”

The role of living‐donor liver transplantation in children with an advanced malignant rhabdoid tumor of the liver in the era of transplant oncology: Case report and literature review

“…3,4 Recently, the expansion of the role of liver transplantation (LT) in the treatment of malignancies has been challenged with some promising results in the era of transplant oncology. [5][6][7][8] However, to our knowledge, there has only been one case report of MRT of the liver that was successfully treated with LT. 9 We herein report a case of MRT of the liver with PVTT that was successfully treated with a combination of living-donor liver transplantation (LDLT) using extracorporeal circulation and pre-and posttransplant chemotherapies. 1A-C).…”

“…Portal vein tumor thrombosis (PVTT) in the main trunk of the portal vein is classified as an advanced stage case and shows poor outcomes, especially in patients with hepatocellular carcinoma 3,4 . Recently, the expansion of the role of liver transplantation (LT) in the treatment of malignancies has been challenged with some promising results in the era of transplant oncology 5–8 . However, to our knowledge, there has only been one case report of MRT of the liver that was successfully treated with LT 9 .…”

Tigecycline causes loss of cell viability mediated by mitochondrial OXPHOS and RAC1 in hepatocellular carcinoma cells

“…There are several treatment options for HCC including surgical resection, liver transplantation, chemoembolization, local ablative procedures, systemic chemotherapy, and checkpoint inhibitor therapy [ 6 ]. Liver transplantation (LT) is preferred for the treatment of HCC patients with underlying hepatic cirrhosis as it achieves 5-year recurrence rates of 15%, whereas recurrence rates after liver resection (LR) can be as high as 70% or more [ 7 , 8 ]. However, LT is limited especially in countries with a lower donor organ pool.…”