Summary Hepatocellular carcinoma (HCC) is a major cause of cancer mortality worldwide and liver transplantation (LT) has potentials to improve survival for patients with HCC. However, expansion of indications beyond Milan Criteria (MC) and use of bridging/downstaging procedures to convert intermediate-advanced stages of HCC within MC limits are counterbalanced by graft shortage and increasing use of marginal donors, partially limited by the use of donor-division protocols applied to the cadaveric and living-donor settings. Several challenges in technique, indications, pre-LT treatments and prioritization policies of patients on the waiting list have to be precised through prospective investigations that have to include individualization of prognosis, biological variables and pathology surrogates as stratification criteria. Also, liver resection has to be rejuvenated in the general algorithm of HCC treatment in the light of salvage transplantation strategies, while benefit of LT for HCC should be determined through newly designed composite scores that are able to capture both efficiency and equity endpoints. Innovative treatments such as radioembolization for HCC associated with portal vein thrombosis and molecular targeted compounds are likely to influence future strategies. Accepting this challenge has been part of the history of LT and will endure so also for the future.

The challenges of liver transplantation for hepatocellular carcinoma on cirrhosis / S. Bhoori, C. Sposito, A. Germini, J. Coppa, V. Mazzaferro. - In: TRANSPLANT INTERNATIONAL. - ISSN 0934-0874. - 23:7(2010), pp. 712-722. [10.1111/j.1432-2277.2010.01111.x]

The challenges of liver transplantation for hepatocellular carcinoma on cirrhosis

S. Bhoori
Primo
;
C. Sposito
Secondo
;
J. Coppa
Penultimo
;
V. Mazzaferro
2010

Abstract

Summary Hepatocellular carcinoma (HCC) is a major cause of cancer mortality worldwide and liver transplantation (LT) has potentials to improve survival for patients with HCC. However, expansion of indications beyond Milan Criteria (MC) and use of bridging/downstaging procedures to convert intermediate-advanced stages of HCC within MC limits are counterbalanced by graft shortage and increasing use of marginal donors, partially limited by the use of donor-division protocols applied to the cadaveric and living-donor settings. Several challenges in technique, indications, pre-LT treatments and prioritization policies of patients on the waiting list have to be precised through prospective investigations that have to include individualization of prognosis, biological variables and pathology surrogates as stratification criteria. Also, liver resection has to be rejuvenated in the general algorithm of HCC treatment in the light of salvage transplantation strategies, while benefit of LT for HCC should be determined through newly designed composite scores that are able to capture both efficiency and equity endpoints. Innovative treatments such as radioembolization for HCC associated with portal vein thrombosis and molecular targeted compounds are likely to influence future strategies. Accepting this challenge has been part of the history of LT and will endure so also for the future.
Benefit; Bridging; Cirrhosis; Downstaging; Hepatocellular carcinoma; Liver transplantation; Milan criteria; Priority; Waiting-list; Carcinoma, Hepatocellular; Catheter Ablation; Chemoembolization, Therapeutic; Hepatectomy; Humans; Liver Cirrhosis; Liver Neoplasms; Liver Transplantation; Living Donors; Patient Selection; Salvage Therapy; Survival Analysis; Waiting Lists; Transplantation; Medicine (all)
Settore MED/18 - Chirurgia Generale
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/2434/458417
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