Liver Transplantation for the Treatment of Moderately or Well-Differentiated Hepatocellular Carcinoma

Abstract

The routine pre-orthotopic liver transplantation tumor grading may represent a valid tool in the selection of unresectable HCC patients for transplantation.

Long-term survival after recurrent hepatocellular carcinoma in liver transplant patients: Clinical patterns and outcome variables

“…Several transplant groups have demonstrated that, apart from number and size of tumor nodules, parameters of tumor biology, such as differentiation and microvascular tumor invasion (MVI) play an important role for predicting patient prognosis, and should be, therefore, incorporated in the pretransplant selection process (4,8,9,10,11). However, since expanding the selection criteria may increase the risk of tumor relapse, its justification will very much depend on outcome of posttransplant HCC recurrence (13)(14)(15)(16)(17)(18)(19) …”

“…As of recent, there is increasing concern that organ allocation based on these stringent selection variables might exclude a significant number of patients who, although not meeting the Milan criteria, would nonetheless benefit from LT (8)(9)(10)(11)(12). Several transplant groups have demonstrated that, apart from number and size of tumor nodules, parameters of tumor biology, such as differentiation and microvascular tumor invasion (MVI) play an important role for predicting patient prognosis, and should be, therefore, incorporated in the pretransplant selection process (4,8,9,10,11).…”

Liver transplantation and expanded Milan criteria: does it really work?

“…However, the criteria proposed by the University of Pittsburgh and some groups in Europe are based, at least in part, on pathological features (nodal invasion, grade, vascular invasion) that are not usually available before transplantation (9,21,50,68) . By contrast, the MC, UCSF and Onaca et al (42) proposal rely on factors (tu- ITT = intention to treat ¥ = patient survival (PS) ² = recurrence free rate (RR) Staging refers to the method used for tumor staging.…”

“…Several studies have shown that some tumor patients transplanted outside of the UNOS and MC survive longer (9,12,16,17,18,36,44,52) and as consequence, several proposals have been made to expand the HCC inclusion criteria (18,28,63,64,65) . However, the criteria proposed by the University of Pittsburgh and some groups in Europe are based, at least in part, on pathological features (nodal invasion, grade, vascular invasion) that are not usually available before transplantation (9,21,50,68) .…”

“…Microvascular invasion was the only factor that predicted poor survival in the multivariate analysis. Indeed, several studies have shown that the differentiation degree and microvascular invasion represent direct indicators of the biologic progression of HCC, being associated with tumor recurrence and poor long-term survival (9,11,18,39,40,45) . Expansion of transplantation inclusion criteria should be made cautiously.…”