Selecting patients with hepatocellular carcinoma for liver transplantation: incorporating tumor biology criteria

Abstract

Liver transplantation (LT) is the optimal therapeutic option for patients with liver cirrhosis and hepatocellular carcinoma (HCC). Due to universal donor shortage, only the patients with limited tumor burden (under the so-called Milan criteria) are considered as potential candidates for LT in most institutions. It is expected that in the near future, more liver grafts will be available for patients with HCC due to the implementation of new direct antivirals against hepatitis C, leaving a prone scenario to consider expanding Milan criteria. A moderate expansion of Milan criteria could be implemented without increasing the risk of tumor recurrence if patients with favorable biological behavior are carefully selected. Incorporating information regarding tumor biology in the decision-making algorithm would result in a more rational use of LT in patients with HCC. In the present review, surrogate markers of tumor biology are critically evaluated as potential tools to be combined with existing radiological criteria. In addition, the current state of liquid biopsy is discussed, as this cutting-edge technology may reshape the management of HCC in the upcoming years.

Expression of MAPK and PI3K/AKT/mTOR Proteins according to the Chronic Liver Disease Etiology in Hepatocellular Carcinoma

“…In the last years, many attempts have been made to identify prognostic and predictive parameters in HCC [ 23 ]. Some of them were evaluated in this study.…”

Outcomes in Hepatocellular Carcinoma Liver Transplantation before and after the Mandated Six-Month Wait Time

“…13,14 A method of detecting tumor byproducts in the bloodstream, liquid biopsy, is being evaluated, which includes identifying circulating-tumor cells or cell-free DNAs as a noninvasive procedure and may aid in not only screening but also in prioritizing candidates on the wait-list. 15…”

Recurrence of Hepatocellular Carcinoma After Liver Transplantation is Associated with Episodes of Acute Rejections

“…8,[11][12][13][14][15] During the past years different studies suggested some non-oncological risk factors in association with HCC recurrence, such as age, prolonged cold ischemia time (CIT; >10 h) and warm ischemia time (WIT; >50 min) as well as blood transfusion. [16][17][18][19][20][21] Of note, biomarkers seem to play a key role in liver inflammation and ultimately tumor recurrence, such as being able to predict outcomes after LT. 22 Particularly the neutrophil lymphocyte ratio (NLR) measured in the peripheral blood was found to be of importance in predicting outcome in several malignancies, including HCC. Several studies found that preoperative elevated NLR is associated with high risk of recurrence and death in patients with HCC undergoing LT. 8,[23][24][25] The incidence of acute rejection (AR) varies from 10% to 64% and its implications on patient outcomes after LT remains controversial.…”