What Are the Optimal Liver Transplantation Criteria for Hepatocellular Carcinoma?

Abstract

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Living Donor Liver Transplantation for Hepatocellular Carcinoma: Appraisal of the United Network for Organ Sharing Modified TNM Staging

“…There is increasing reliance on tumor biology for LT in HCC, and extension beyond absolute cutoffs on tumor size and numbers is being investigated. Biomarkers like AFP and prothrombin induced by vitamin K absence II (PIVKA II) are being incorporated into treatment algorithms for HCC ( 12 ). Response to preoperative LRT is a potential surrogate for tumor biology and those with favorable response have improved post-transplant outcomes ( 4 ).…”

Hepatocellular Carcinoma—How to Determine Therapeutic Options

“…(41) Several additional selection criteria have been developed further in the pretransplant setting to more accurately predict an individual's expected post-LT survival. (42,43) Most models incorporate serum biomarkers in addition to various tumor size and number cutoffs, although other criteria incorporate either 18 F-FDG PET scan (44) or tumor differentiation (45) for patients beyond Milan criteria.…”

“…Although the Milan criteria remain the gold standard for candidate selection in the United States, there is now a plethora of evidence indicating that tumor size and number alone do not solely determine a patient’s expected post‐LT outcome . Several additional selection criteria have been developed further in the pretransplant setting to more accurately predict an individual’s expected post‐LT survival . Most models incorporate serum biomarkers in addition to various tumor size and number cutoffs, although other criteria incorporate either 18 F ‐ FDG PET scan or tumor differentiation for patients beyond Milan criteria.…”

Risk assessment criteria in liver transplantation for hepatocellular carcinoma: proposal to improve transplant oncology

“…With many tools to choose from, the question of what exactly to include in a criteria to best determine LT candidacy is up for debate. It is widely accepted that at minimum there must be a combination of tumor morphology and tumor biology (most commonly assessed through serum markers such as AFP) [ 5 , 48 ]. This claim is supported by the fact that the vast majority of newer proposed scores include a combination of tumor morphology and biology while older scores (Up-to-Seven, University of California San Francisco [UCSF] and Tokyo Criteria) only include tumor morphology ( Figure 1 ).…”

“…In this article, the authors will summarize the current utility of MC, investigate the utility of other important criteria, provide a summary of the data for a selected group of proposed criteria and finally review considerations and key questions to improve the utility of future criteria. While there are a number of well written articles that assess a wide verity of topics related to HCC risk assessment in LT such as their use around the world [ 4 ] and optimal metrics for LT of HCC [ 5 ]. The goal of this article is to leave the reader with a better understanding of the current utility of proposed criteria for HCC and enrich a discussion on how the field can address critical questions surrounding these tools, to gain wider acceptance.…”