Key Points: 1 Liver transplantation (LT) is considered to be the first-line treatment option for patients with hepatocellular carcinoma (HCC) within Milan criteria not suitable for resection. 2 Extension of tumor limit criteria has not been well established. Modest expansion of Milan criteria applying the “up-to-7” in patients without macrovascular invasion achieves competitive outcomes. 3 Neoadjuvant treatment can be considered before LT (downstaging). 4 After LT, an immunosuppressive regimen containing calcineurin inhibitors has been associated in a dose-dependent fashion with an increased risk of posttransplant HCC recurrence, whereas promising results come from the use of mammalian target of rapamycin inhibitor. 5 Further studies are needed to guarantee allocation equity between patients with and patients without HCC who are waiting for LT.
HCC criteria for liver transplantation: Controversies
BURRA, PATRIZIA;Zanetto, Alberto;RODRIGUEZ CASTRO, KRYSSIA ISABEL
2015
Abstract
Key Points: 1 Liver transplantation (LT) is considered to be the first-line treatment option for patients with hepatocellular carcinoma (HCC) within Milan criteria not suitable for resection. 2 Extension of tumor limit criteria has not been well established. Modest expansion of Milan criteria applying the “up-to-7” in patients without macrovascular invasion achieves competitive outcomes. 3 Neoadjuvant treatment can be considered before LT (downstaging). 4 After LT, an immunosuppressive regimen containing calcineurin inhibitors has been associated in a dose-dependent fashion with an increased risk of posttransplant HCC recurrence, whereas promising results come from the use of mammalian target of rapamycin inhibitor. 5 Further studies are needed to guarantee allocation equity between patients with and patients without HCC who are waiting for LT.
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