Liver Transplantation for Hepatocellular Carcinoma. Working Group Report from the ILTS Transplant Oncology Consensus Conference

Mehta, Neil; Bhangui, Prashant; Yao, Francis Y.; Mazzaferro, Vincenzo; Toso, Christian; Akamatsu, Nobuhisa; Durand, François; IJzermans, Jan N.M.; Polak, Wojciech; Zheng, Shusen; Roberts, John P.; Sapisochín, Gonzalo; Hibi, Taizo; Kwan, Nancy Man; Ghobrial, R. Mark; Soin, AS

doi:10.1097/tp.0000000000003174

Cited by 140 publications

(98 citation statements)

References 107 publications

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“…The recent International Liver Transplantation Society Consensus Conference guidelines state that a minimum 5‐year post‐LDLT survival of 60% is an acceptable benchmark. ( 36 ) Using our expanded selection criteria, post‐LDLT 5‐year OS was 64%, excluding postoperative deaths it was 69%, and in the 300‐patient cohort it was 74%.…”

Section: Discussionmentioning

confidence: 99%

Incorporating Tumor Biology to Predict Hepatocellular Carcinoma Recurrence in Patients Undergoing Living Donor Liver Transplantation Using Expanded Selection Criteria

et al. 2021

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Conventional selection criteria for liver transplantation (LT) in patients with hepatocellular carcinoma (HCC) are based on tumour size/number only, and do not consider vital surrogates of tumor biology such as alpha‐fetoprotein (AFP) and tumor [18F]fluorodeoxyglucose positron emission tomography ([18F]FDG PET) avidity. We analyzed survival outcomes, and predictors of HCC recurrence in 405 patients with cirrhosis and HCC (HCC‐cirr) who underwent living donor LT (LDLT) using our expanded selection criteria: no extrahepatic disease or major vascular invasion, irrespective of tumor size/number. Fifty‐one percent patients had tumours beyond Milan, and 43% beyond the University of California San Francisco [UCSF] criteria. The 5‐year overall survival (OS) and recurrence‐free survival (RFS) were 64% and 70%, respectively. Three preoperatively available factors predicted recurrence: pre‐LT AFP ≥100 ng/mL (P = 0.005; hazard ratio [HR], 2.190), tumor burden beyond the UCSF criteria (P = 0.001; HR, 2.640), and [18F]FDG PET avidity (P = 0.004; HR, 2.442). A prognostic model based on the number and combination of the aforementioned preoperative risk factors was developed using a competing‐risk RFS model. Three risk groups were identified: low (none or a single risk factor present, 9.3% recurrence), moderate (AFP ≥100 ng/mL and [18F]FDG PET avidity, or beyond UCSF tumor and [18F]FDG PET avidity, 25% recurrence), and high (AFP ≥100 ng/mL and beyond UCSF, or presence of all 3 risk factors, 46% recurrence). Acceptable long‐term outcomes were achieved using our expanded selection criteria. Our prognostic model to predict recurrence based on preoperative biological and morphological factors could guide pretransplant management (downstaging versus upfront LDLT) with the aim of reducing post‐LDLT recurrence.

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Section: Discussionmentioning

confidence: 99%

Incorporating Tumor Biology to Predict Hepatocellular Carcinoma Recurrence in Patients Undergoing Living Donor Liver Transplantation Using Expanded Selection Criteria

et al. 2021

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“…Non-Hodgkin lymphoma is the most common non-skin cancer in people living with a liver transplant. In solid organ transplant recipients, high short-term risk is associated with more intense immunosuppression and lack of immunological control of EBV infection in the early period [5,19] . However, an excess risk is also observed many years after transplantation.…”

Section: Cancer Riskmentioning

confidence: 99%

“…This excess cancer risk is predominantly attributed to exposure to medical immunosuppression [1] , but other known carcinogenic exposures before and after transplantation such as infection with an oncogenic virus, smoking, heavy alcohol consumption and sun exposure, are also contributing factors [2] . Recipients of liver transplants have a lower risk of cancer compared to recipients of cardiothoracic organs and kidneys, due to generally lower overall doses of immunosuppression [3][4][5] .…”

Section: Introductionmentioning

confidence: 99%

Extrahepatic cancer risk after liver transplantation for hepatocellular carcinoma: incidence, risk and prevention

Vajdic¹,

Leeuwen²,

McCaughan³

2021

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This article synthesises the current evidence on the risk of de novo extrahepatic cancer in people living with a liver transplant after hepatocellular carcinoma, the risk factors for cancer, and the recommended approaches to cancer prevention and surveillance. People living with a transplanted liver have an elevated risk of cancer and cancer death, and the indication for transplantation does not markedly alter the cancer risk. The excess risk of cancer is double that of the age-and sex-matched general population. Virus-related cancers, especially non-Hodgkin lymphoma, Kaposi sarcoma, Merkel cell carcinoma, oral, and anogenital cancers occur at increased risk, as do cancers causally associated with high prior sun exposure, smoking and excessive alcohol consumption, including skin, oesophageal, larynx, lung, kidney, and bladder cancer. The risk of incident breast and prostate cancer is not increased. Cancer-related deaths largely mirror that for cancer incidence, and extend to include the more common malignancies such as breast, colorectal, prostate cancer and non-melanoma skin cancer. As medical immunosuppression is the principal risk factor for cancer, the regimen should be reviewed on a regular basis to achieve immunosuppression minimisation. An individual, risk-based approach to cancer screening according to test characteristics and personal and family cancer history, medical history, lifestyle factors, and life expectancy is recommended. Multicomponent interventions may achieve the best results in supporting the adoption and maintenance of cancer risk-reducing behaviours. Regular, empowering patient counselling and education is a cornerstone for the care of people living with a liver transplant.

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“…Úloha lokoregionální léčby jako "bridging" terapie během doby čekání na transplantaci u pacientů, kteří transplantační kritéria splňují, není jednoznačně prokázána. Dle ně kte rých názorů se zdá tento přístup ospravedlnitelný a je doporučen [31].…”

Section: Downstaging Bridging a Neoadjuvantní Léčba Hcc Před Transplunclassified

Hepatocellular carcinoma from the view of a transplant surgeon

Kočík¹,

Taimr²,

Froněk³

2020

Klin Onkol

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Liver Transplantation for Hepatocellular Carcinoma. Working Group Report from the ILTS Transplant Oncology Consensus Conference

Cited by 140 publications

References 107 publications

Incorporating Tumor Biology to Predict Hepatocellular Carcinoma Recurrence in Patients Undergoing Living Donor Liver Transplantation Using Expanded Selection Criteria

Incorporating Tumor Biology to Predict Hepatocellular Carcinoma Recurrence in Patients Undergoing Living Donor Liver Transplantation Using Expanded Selection Criteria

Extrahepatic cancer risk after liver transplantation for hepatocellular carcinoma: incidence, risk and prevention

Hepatocellular carcinoma from the view of a transplant surgeon

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