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Liver transplantation for hepatocellular carcinoma: a survey of practices
Erik J Van Kleek1, Jonathan M Schwartz, Stephen C Rayhill
1Department of Internal Medicine, Oregon Health and Sciences University, Portland, OR 97239, USA.
Goal:
To survey physician practices regarding liver transplantation for patients with hepatocellular carcinoma (HCC).
Background:
Many issues surrounding liver transplantation for HCC are controversial and physician practices have not been well characterized.
Methods:
Transplant physicians and surgeons were electronically surveyed regarding surveillance, diagnosis, selection criteria for deceased and living donor transplantation, and use of adjunctive therapy for HCC.
Results:
Eighty-nine of 174 (51%) physicians completed the survey (39 hepatologists, 41 transplant surgeons, and 9 others). Most respondents were from large US transplant centers. All reported screening for HCC during transplant evaluation, and 98% surveyed patients awaiting transplant. Sixty percent of respondents would biopsy lesions under selective conditions, whereas 32% never biopsy lesions, and 8% biopsy all lesions. Eighty two percent of respondents claimed to adhere to the Milan criteria (single lesion
Conclusions:
There is consistency related to HCC surveillance and treatment in liver transplant candidates. Variations of responses regarding biopsy of lesions, patient selection for deceased donor and living donor transplantation highlight a need for evidence-based guidelines.
