Liver Transplantation for HCC: A Review

Area of Science:

• Hepatology and Transplant Surgery
• Oncology and Surgical Oncology

Background:

• Hepatocellular carcinoma (HCC) frequently develops in patients with chronic liver disease or cirrhosis.
• Liver transplantation offers a curative option for HCC, addressing both the tumor and the underlying liver condition.

Purpose of the Study:

• To evaluate the efficacy of liver transplantation for hepatocellular carcinoma (HCC) under various selection criteria.
• To assess the role of living donor liver transplantation and tumor downstaging in managing HCC.

Main Methods:

• Review of patient selection criteria for liver transplantation in HCC, including tumor size, number, volume, and biological features.
• Analysis of outcomes associated with expanded selection criteria beyond the Milan criteria.
• Evaluation of living donor liver transplantation and tumor downstaging strategies.

Main Results:

• The Milan criteria, while a benchmark, have been found to be restrictive; modest expansion shows equivalent survival.
• Microvascular invasion is identified as the most significant negative prognostic factor for survival.
• Living donor liver transplantation provides viable options for larger or more numerous tumors without microvascular invasion, with acceptable outcomes.

Conclusions:

• Liver transplantation is the optimal treatment for HCC in cirrhotic livers and massive HCC in non-cirrhotic livers, necessitating careful patient selection.
• Expanded selection criteria and living donor liver transplantation enhance treatment accessibility and outcomes for HCC patients.
• Tumor downstaging techniques require further optimization due to variable success rates in managing HCC progression.