Liver Transplantation for Advanced Hepatocellular Carcinoma

Abstract

There has been ongoing debate that the Milan criteria may be too strict that a significant number of patients who could benefit from liver transplantation (LT) might have been excluded. Based on this idea, various studies have been conducted to further expand the Milan criteria and give more HCC patients a chance of cure. In deceased donor LT (DDLT) setting, expansion of the criteria is relatively tempered because the results of LT for HCC should be comparable to those of patients with non-malignant indications. On the other hand, in living donor LT (LDLT) situation, liver grafts are not public resources. The acceptable target outcomes for LDLT might be much lower than those for DDLT. Patients with biologically favorable tumors might have excellent survivals after LT despite morphological advanced HCCs. Therefore, the significance and utility of biological tumor parameters for selecting suitable LT candidates have been increased to predict HCC recurrence after LT. Although there is no consensus regarding the use of prognostic biomarkers in LT selection criteria for HCC, the combination of conventional morphological parameters and new promising biomarkers could help us refine and expand the LT criteria for HCC in the near future. developed the expanded criteria of their own. Some of them use biological parameters as well as conventional morphological factors to select patients suitable to LT. 5 The increasing importance of biologic parameters is leading to a paradigm shift in LT patient selection criteria. This article aims at reviewing new strategies proposed to perform LT for more advanced HCC.

Impact of immunosuppressant therapy on early recurrence of hepatocellular carcinoma after liver transplantation

“…Consistent with other studies, pre-transplant MVI, AFP and PIVKA-II levels, were significantly and independently correlated with HCC recurrence 28,29,30,31,32,33,34,35,36. Pre-operative needle core biopsy provides exact histological information on tumors, but this procedure is not recommended due to the risk of tumor seeding.…”