Liver transplantation for malignancy: Current treatment strategies and future perspectives

Hackl, Christina; Kirchner, Gabriele I.; Knoppke, Birgit; Loss, Martin

doi:10.3748/wjg.v20.i18.5331

Cited by 39 publications

(37 citation statements)

References 144 publications

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“…In borderlineresectab le hepatoblastoma, LT should be considered since long-term OSwas shown to be 85% to 90% in patients receiving primary LT for hepatoblastoma compared with25% to 40% in rescue transplant for recurrent disease after prior liver resection. 4 Neuroendocrine liver metastases Neuroendocrine carcinomas were first described in 1907 by Siegfried Oberndorfer. 24 Neuroendocrine carcinomas have an incidence of ≤ 5 per 100 000, show variable locations, and have a variable natural course of the disease.…”

Section: Hepatoblastomamentioning

confidence: 99%

“…Current National Comprehensive Cancer Networkguidelines define LT for neuroendocrine liver metastasesas an investigational procedure, with research ongoing to define predictors for patient selection. 4 Colorectal cancer liver metastasis The primary metastatic site for patients diagnosed with colorectal cancer is the liver, with 60% to 70% of metastatic recurrences in patients with colorectal cancer occurring in the liver and up to 35% of metastatic colorectal cancer patients having metastases only in this organ. 31 Up to now, colorectal liver metastasis is a contraindication for LT due to (1) allocation justice in light of deceased-donor organ shortages and (2) high rates of tumor recurrence after transplant.…”

Section: Hepatoblastomamentioning

confidence: 99%

“…Liver transplant has been proposed for patients with hepatic epithelioid hemangioendothelioma having a diffuse disease pattern, tumor size >10 cm, >10 nodules, and greater than 4 segments of hepatic involvement. 21 In an analysis of several series involving more than 5 patients and 2 reviews analyzing LT for hepatic epithelioid hemangioendothelioma, including synopses of United Network for Organ Sharing (UNOS), European, and Canadian databases, Hackl and associates concluded that, with 5-year OS at 83% (even in the presence of extrahepatic disease) and 5-year diease-free survival at 46% to 82%, the outcome of LT for hepatic epithelioid hemangioendothelioma is comparable with nonmalignant indications for LT. 4 Therefore, LT should be offered to all patients with unresectable hepatic epithelioid hemangioendothelioma or resectable hepatic epithe lioid hemangioendothelioma with unfavorable predictors. 4 …”

Section: Introductionmentioning

confidence: 99%

“…Table 1 summarizes indications and contraindications for LT in patients with malignancies. 4 In addition to hepatocellular carcinoma (HCC), hepatoblastoma and epithelioid hemangioendothelioma are also standard indications for LT. Investigational indications include cho langiocarcinoma and neuroendocrine liver metastases. However, hepatoblastoma with uncontrolled extrahepatic disease is a contraindication for LT.…”

Section: Introductionmentioning

confidence: 99%

“…In contrast to HCC, cholangiocarcinoma originates in the bile duct epithelium and can be defined as intrahepatic, perihilar, or distal cholangiocarcinoma. 4 Invasion into the main portal vein, common hepatic artery, or into 1 lobe of the liver with invasion of the contralateral branch of the portalvein or hepatic artery are criteria for unresectability. 9,10 In an analysis of various studies about survival after LT for cholangiocarcinoma, Castaldo and associates 11 showed that 5-year OS rates were between 0% and 42% (range, 0%-83%).…”

Section: Introductionmentioning

confidence: 99%

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Haberal

2017

Exp Clin Transplant

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Liver transplant is now an acceptable and effective treatment for specific nonhepatocellular malignancies. Worldwide, hilar cholangiocarcinoma accounts for 3% of all primary gastrointestinal malignancies and for 10% of primary hepatobiliary malignancies. For patients who have early-stage, unresectable cholangiocarcinoma, liver transplant preceded by neoadjuvant radiotherapy can result in tumor-free margins, accomplish a radical resection, and treat the underlying primary sclerosing cholangitis when present. Hepatic epithelioid hemangioendothelioma is a rare tumor of vascular origin with a variable malignant potential. Excellent results have been reported with liver transplant for patients with unresectable hepatic epithelioid hemangioendothelioma, with 1-year and 10-year survival rates of 96% and 72%. Hepatoblastoma is the most common primary hepatic malignancy in children. The long-term survival rate after transplant ranges from 66% to 77% in patients with unresectable tumors and good response to chemotherapy. Metastatic liver disease is not an indication for liver transplant, with the exception of cases in which the primary tumor is a neuroendocrine tumor. Indication for liver transplant for hepatic metastasis from neuroendocrine tumors is mainly for patients with unresectable tumors and for palliation of medically uncontrollable symptoms. Posttransplant survival in those patients with low tumor activity index is excellent, despite recurrence of the tumor. Some recent data on liver transplant for unresectable hepatic metastases from colorectal cancer have reported limited survival benefits compared with previous reports. However, due to the high rate of tumor recurrence in a very short time after liver transplant, especially in the era of organ shortage, this indication has not been favored by the transplant community. The indications for liver transplant for nonhepatocellular carcinoma malignancy and its limitations have evolved dramatically over the past decades and will continue to be redefined through future research and investigations.

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Section: Hepatoblastomamentioning

confidence: 99%

Section: Hepatoblastomamentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Untitled

Haberal

2017

Exp Clin Transplant

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Liver transplantation for secondary liver tumours

Lerut

Foss

2015

British Journal of Surgery

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Liver transplantation (LT) for malignant liver diseases represents up to 50 per cent of all indications for this operation. Hepatocellular cancer is the most common of these indications and, when the Milan criteria are applied, 5-year disease-free survival (DFS) rates of 75-85 per cent have been obtained. Recently, these criteria have been widened successfully, based on both tumour morphology and biology combined with different locoregional treatments designed to downstage disease. The success of LT in the treatment of primary liver tumours has led to renewed interest in its role as a treatment for secondary liver tumours (SLTs) 1 -4 . Standard treatment for SLTs includes a combination of chemotherapy and liver resection. Lately, liver resectability has been increased markedly as a result of more effective chemotherapy, parenchyma-sparing operations and/or staged surgical procedures. Further extension of survival can also be achieved by incorporating ablative procedures, arterial embolization, and hormone and radiolabelled chemotherapies into treatment protocols including resection. Despite these advances, curative liver resection remains applicable in only 20 per cent of patients, owing mainly to multifocality and the extent of bilobar disease.Total hepatectomy followed by transplantation for liver-only secondaries is by definition an R0 procedure and is therefore a potentially curative therapy. For metastases from neuroendocrine tumours (NETs), 5-year overall survival and DFS rates ranging from 36 to 92 per cent and from 9 to 78 per cent respectively have been reported. For colorectal metastases, 5-year overall survival rates of 60 per cent have been reached 1,2 . These results are comparable to those of state-of-the-art oncological treatments and therefore merit further investigation based on refined selection criteria and neoadjuvant and adjuvant therapies.Gastroenteropancreatic NETs are often diagnosed at an advanced stage. Fortunately the metastatic disease often remains confined to the liver, so R0 primary tumour resection and liver resection may represent a curative option. Liver resection is rarely appropriate, however, as detailed intraoperative imaging and thin-slice examination of the resected parenchyma often reveals many more lesions than those identified by routine imaging and pathology 5,6 . Until recently LT experience for NET was based on small single-centre and heterogeneous multicentre experiences. Recent reports, however, have shed new light on the value of LT 1,7 . The European Liver Transplant Registry 1 and Milan 7 series, including 213 and 24 recipients respectively, identified a number of factors as a prerequisite for success: presence of a well differentiated, low-grade tumour with Ki-67 less than 5-10 per cent; primary tumour localization within the portal venous drainage area; tumour burden less than 50 per cent of liver volume; age below 55 years; response to pre-LT treatment with somatostatin analogues and m-Tor inhibitors; and stable or controlled disease for at least 6 months. To...

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Surgical Therapies in Hepatocellular Carcinoma

Hester

Yopp

2019

Molecular and Translational Medicine

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Liver transplantation for malignancy: Current treatment strategies and future perspectives

Cited by 39 publications

References 144 publications

Untitled

Untitled

Liver transplantation for secondary liver tumours

Surgical Therapies in Hepatocellular Carcinoma

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