Liver transplantation for hepatocellular carcinoma - non-cancer factors and implications for improving outcome beyond standard tumor criteria

Abstract

How to cite this article: Kornberg A, Schernhammer M. Liver transplantation for hepatocellular carcinoma -non-cancer factors and implications for improving outcome beyond standard tumor criteria. Hepatoma Res 2018;4:60. http://dx. AbstractLiver transplantation (LT) is recognized as best treatment option in patients with early hepatocellular cancer (HCC) in underlying liver cirrhosis. Apart from tumor size and number implemented in the Milan criteria, which are current worldwide standards for patient selection, several biological tumor factors have been identified to affect cancer-specific outcome. In particular, grading and vascular tumor invasions were shown to correlate with aggressive biological tumor behavior and poor survival following LT. Identifying tumors with favorable biology is one important approach for expanding the pool of eligible liver recipients beyond the Milan burden limits. Improving the immunological state and condition for appropriate defense against circulating cancer cell attack may be another important prognostic aspect. Therefore, there is increasing interest in non-cancer factors related to the peritransplant period that may influence the oncological outcome by providing negative immunomodulatory actions. Considering and modulation of these non-HCC factors of prognosis might contribute in safely expanding the HCC LT selection criteria.

Does mTORi base immunosuppression offer survival advantage after liver transplantation for hepatocellular carcinoma? Systematic review and meta-analysis of randomized controlled trials

“…[ 10 , 11 , 13 , 26 ] The main agents are sirolimus and everolimus and one of the advantages of these agents is the fact that they have been associated with improved survival after LT for HCC with reduced tumor recurrence. [ 3 , 13 , 21 ]…”

“…Liver transplantation (LT) is the most effective treatment for HCC with background liver cirrhosis; it completely removes the lesion and the liver cirrhosis. [ 2 , 3 ] HCC currently accounts for up to 20-40% of all LT. [ 4 ]…”

“…Another potential advantage of these agents is the fact that they have been associated with improved survival after LT for HCC with reduced tumor recurrence. [ 3 , 10 - 13 ]…”

“…Liver transplantation (LT) is the most effective treatment for HCC with background liver cirrhosis; it completely removes the lesion and the liver cirrhosis. [2,3] HCC currently accounts for up to 20-40% of all LT. [4] The short-term prognosis of patients with HCC after LT has significantly improved, with most studies reporting a 5-year survival rate of >50%. Despite the improvement of survival, recurrence is still a problem for LT for HCC.…”

“…They have been found to have anti-proliferative and anti-angiogenic effects. [3,[10][11][12][13] The main agents are sirolimus and everolimus. These agents are mainly used because of their low nephrotoxicity profile.…”