Hepatocellular carcinoma: Ablate and wait versus rapid transplantation

Area of Science:

• Hepatobiliary surgery
• Transplant oncology
• Medical decision-making

Background:

• Liver transplantation is a curative option for hepatocellular carcinoma (HCC).
• The Milan criteria define patients with favorable outcomes post-transplant.
• Tumor burden outside Milan criteria often leads to recurrence.

Purpose of the Study:

• To evaluate the efficacy of an "ablate and wait" strategy for HCC patients undergoing liver transplantation.
• To determine if this strategy improves recurrence-free survival.
• To assess the applicability of this strategy for both Milan criteria and expanded criteria patients.

Main Methods:

• Review of University of California San Francisco's downstaging experience.
• Tumor ablation followed by a waiting period.
• Radiological assessment of tumor biology during the waiting period.

Main Results:

• Patients outside Milan criteria treated with "ablate and wait" achieved outcomes comparable to those within Milan criteria.
• The waiting period allows for the assessment of tumor biology.
• This strategy may decrease recurrence risk.

Conclusions:

• Expansion beyond Milan criteria for liver transplantation should incorporate an "ablate and wait" approach.
• The "ablate and wait" strategy should be considered even for patients within Milan criteria.
• This approach helps mitigate recurrence risk by evaluating tumor biology.