Hepatocellular carcinoma: when is liver transplantation oncologically futile?

Viveiros, André; Zoller, Heinz; Finkenstedt, Armin

doi:10.21037/tgh.2017.07.03

Cited by 20 publications

(13 citation statements)

References 54 publications

(84 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…For liver transplantation (LT) in patients with “expanded” criteria, HCC has been extensively studied and has been discussed elsewhere . The focus of this review is on LT for “expanded criteria” CCC, metastatic NETs, and colorectal cancer.…”

Section: Expanded Criteriamentioning

confidence: 99%

Con: Liver transplantation for expanded criteria malignant diseases

Schaefer¹,

Zoller²,

Schneeberger

2017

Liver Transpl

Self Cite

View full text Add to dashboard Cite

Organ shortage requires policies and guidelines to aid organ allocation along the principles of urgency or utility. Identifying patients with significant benefit and withholding liver transplantation (LT) from patients too sick for transplantation are ongoing challenges, in particular in patients with malignancies. An arbitrary threshold of >50% 5-year overall survival (OS) is broadly considered a minimum standard for LT. In patients transplanted for intrahepatic cholangiocarcinoma (iCC), this was only achieved in select cases and when the tumor had a diameter of <2 cm. In patients with extrahepatic and hilar cholangiocarcinoma (CCC), strict selection criteria and combined preoperative radiotherapy/chemotherapy according to the Mayo protocol showed that acceptable longterm results can be achieved in a single high-volume center but are difficult to repeat elsewhere. Furthermore, only rigorously selected patients with neuroendocrine tumors (NETs) meeting the NET Milan criteria adopted by United Network for Organ Sharing can also have >50% 5-year OS. A prospective study in patients with unresectable colorectal cancer metastases in the liver has shown promising OS rates, but further prospective trials are warranted. Current evidence shows that none of the proposed expanded malignant criteria justify deviation of scarce donor organs to patients with hilar CCC, iCC > 2 cm, metastatic NET beyond NET Milan criteria, or metastatic colorectal cancer (CRC) outside clinical trials.Liver Transplantation 24 104-111 2018 AASLD.Received September 1, 2017; accepted October 4, 2017. Utility of Liver Transplantation for Malignant DiseasesListing, delisting, and allocation policies aim at selecting patients with a projected 5-year survival rate of over 50% and is referred to as rationing. (1) As a result, allocation and distribution policies are not restricted to the best interest of an individual patient. To avoid ethical conflicts and litigations for physicians, treatment guidelines and allocation policies have been introduced by national transplant programs. (2) These recommendations and policies are based on empirical data with the aim to allocate donor livers to patients with the greatest need and best utility to society. (1) Recent reports suggest that selected patients with hepatobiliary malignancies despite advanced tumor stage but favorable tumor biology can have outcomes that are at least equivalent or even better than patients meeting conventional listing criteria. Expanded CriteriaIndividual candidates with tumors exceeding these criteria or with neuroendocrine tumors (NETs) or

show abstract

Section: Expanded Criteriamentioning

confidence: 99%

Con: Liver transplantation for expanded criteria malignant diseases

Schaefer¹,

Zoller²,

Schneeberger

2017

Liver Transpl

Self Cite

View full text Add to dashboard Cite

show abstract

“…The use of expanded criteria for LT using the University of California San Francisco (UCSF) or up-to-7 (168,169,(217)(218)(219)(220)(221)(222)(223)(224) criteria has been associated with increased risk of tumor recurrence, not being adopted in Brazil by the National Transplant System, particularly in those patients on the LT waitlist whose disease has progressed despite locoregional treatment (223,224) .…”

Section: Intermediate Hcc -Bclc Bmentioning

confidence: 99%

Brazilian Society of Hepatology Updated Recommendations for Diagnosis and Treatment of Hepatocellular Carcinoma

Chagas

Mattos

Carrilho

et al. 2020

Arq. Gastroenterol.

View full text Add to dashboard Cite

Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related mortality worldwide. The Brazilian Society of Hepatology (SBH) published in 2015 its first recommendations about the management of HCC. Since then, new data have emerged in the literature, prompting the governing board of SBH to sponsor a single-topic meeting in August 2018 in São Paulo. All the invited experts were asked to make a systematic review of the literature reviewing the management of HCC in subjects with cirrhosis. After the meeting, all panelists gathered together for the discussion of the topics and the elaboration of updated recommendations. The text was subsequently submitted for suggestions and approval of all members of the Brazilian Society of Hepatology through its homepage. The present manuscript is the final version of the reviewed manuscript containing the recommendations of SBH.

show abstract

“…Therefore, it could theoretically help in the selection of a subgroup of patients with HCC that initially exceeds transplant criteria but that will probably do well after LT. As recent studies confirmed, another crucial factor is represented by tumor biology, which can be summed up in two prognostic elements, poor differentiation, and MVI that are associated with recurrence in patients within and beyond various transplant criteria. Conversely, the absence of these risk factors may justify LT also in patients with larger HCC [ 67 ].…”

Section: The Importance Of Downstaging: When Lt Is Feasible?mentioning

confidence: 99%

Microvascular Invasion in HCC: The Molecular Imaging Perspective

Cuccurullo

Stasio

Mazzarella

et al. 2018

Contrast Media & Molecular Imaging

View full text Add to dashboard Cite

Hepatocellular carcinoma represents the most frequent primary liver tumor; curative options are only surgical resection and liver transplantation. From 1996, Milan Criteria are applied in consideration of patients with cirrhosis and hepatocellular for liver transplantation; nonetheless, more recently, Milan Criteria have been criticized because they appear over conservative. Apart from number and size of lesions and biomarker levels, which already have been associated with poorer prognosis, overall survival and recurrence rates after transplantation are affected also by the presence of vascular invasion. Microvascular invasion suggests a poor prognosis but it is often hard to detect before transplant. Diagnostic imaging and tumor markers may play an important role and become the main tools to define microvascular invasion. In particular, a possible role could be found for computed tomography, magnetic resonance imaging, and positron emission tomography. In this paper, we analyze the possible role of positron emission tomography as a preoperative imaging biomarker capable of predicting microvascular invasion in patients with hepatocellular carcinoma and thus selecting optimal candidates for liver transplantation.

show abstract

Hepatocellular carcinoma: when is liver transplantation oncologically futile?

Cited by 20 publications

References 54 publications

Con: Liver transplantation for expanded criteria malignant diseases

Con: Liver transplantation for expanded criteria malignant diseases

Brazilian Society of Hepatology Updated Recommendations for Diagnosis and Treatment of Hepatocellular Carcinoma

Microvascular Invasion in HCC: The Molecular Imaging Perspective

Contact Info

Product

Resources

About