Liver Transplantation in Malignancies: A Comprehensive and Systematic Review on Oncological Outcome

Abstract

<b><i>Introduction:</i></b> Liver transplantation (LT) is today’s standard treatment for both end-stage liver disease and tumors; however, suitable grafts for LT are a scarce resource and outcome after LT is highly dependent on its underlying indication. Thus, patients must be carefully selected to optimize the number of life years gained per graft. This comprehensive and systematic review critically reflects the most recently published oncological outcome data after LT in malignancies based on the preoperative radiological findings. <b><i>Methods:</i></b> A systematic literature search was conducted to detect preferentially most recent high-volume series or large database analysis on oncological outcomes after LT for both primary liver cancer and liver metastases between January 1, 2019, and November 14, 2020. A comprehensive review on the radiological assessment of the reviewed liver malignancies is included and its preoperative value for an outcome-driven indication reflected. <b><i>Results:</i></b> Twenty most recent high-volume or relevant studies including a total number of 2,521 patients were identified including 4, 4, 4, 4, 3, and 1 publications on oncological outcome after LT for hepatocellular carcinoma, cholangiocellular carcinoma, hepatic epitheloid hemangioendothelioma, hepatoblastoma, and both metastatic neuroendocrine tumors and colorectal cancer, respectively. The overall survival is comparable to patients without tumors if patients with malignancies are well selected for LT; however, this is highly dependent on tumor entity, tumor stage, and both neoadjuvant and concomitant treatment. <b><i>Discussion/Conclusion:</i></b> LT is a promising option for better survival in patients with malignant liver tumors in selected patients; however, the indication must be critically discussed prior to LT in every single case in the context of organ shortage.

Liver transplantation in the management of cholangiocarcinoma: Evolution and contemporary advances

“…The development of improved organ preservation solutions, most notably the University of Wisconsin solution in 1988[ 18 ], allowed greater cold ischaemic times with consequent reductions in vascular and biliary complications[ 19 ]. At present, liver malignancies indicated for LT in well selected patients include hepatocellular carcinoma (HCC), hepatic epitheloid hemangioendothelioma, hepatoblastoma and metastatic neuroendocrine tumours, while an increasing interest is developing about its role in CCA and metastatic colorectal cancer[ 20 ].…”

Liver Transplant Oncology: Towards Dynamic Tumor-Biology-Oriented Patient Selection

“…Good responses can be achieved with platinum-based neoadjuvant regimens; children subsequently undergo curative liver resection, even in selected patients with POST-TEXT III or IV [ 50 ]. However, in some cases, despite chemotherapy, liver resection is technically not feasible, e.g., in central lesions, involvement of major vessels (P or V) or multifocal disease, leaving liver transplantation as the only remaining curative treatment option with long-term recurrence free survival (RFS) [ 51 ].…”

“…Outcome after LT in HB in general is excellent. Recurrence rates for HB are 0% for LT at 5 years and hence much better than after resection (~10%); 5-year survival was more than 80% [ 51 , 54 ]. Higher risk in HB is classified by the Children’s Hepatic tumors International Collaboration (CHIC) [ 55 ] by several parameters, including histology (pure fetal better than small cell undifferentiated), biological behavior (worse prognosis with lower AFP levels <100 U/mL, spontaneous tumor rupture at involvement or locally advanced tumors with macroscopic vascular invasion and metastatic disease), and age at time of diagnosis [ 56 ].…”

Liver transplantation for hepatoblastoma

“…In the current era, indocyanine green (ICG)-guided minimally invasive surgery for the clearance of metastasis seems to have gained popularity among surgeons [17,19,20,67] . ICG is an organic anion that is directly taken up by bile; thus, it does not undergo biotransformation or enterohepatic circulation [68] . ICG is actively taken up by the cells of the hepatoblastoma, but these cells delay the excretion of the molecule in the bile, and this longer retention of ICG in the cancerous tissue facilitates the visualization of the hepatoblastoma in near-infrared mode (NIR) [17] .…”