Living donor liver transplantation for patients with advanced hepatocellular carcinoma

Abstract

Liver transplantation (LT) is the treatment of choice for patients with hepatocellular carcinoma (HCC) and underlying liver disease. Given the organ scarcity, LT for patients with HCC have been restricted to those patients associated with the highest survivals. However, many patients with extended criteria HCC can still benefit from LT, but due to deceased organ shortage, they are not offered that opportunity. Living donor liver transplantation (LDLT) emerged as a successful strategy to overcome organ shortage around the world and as LDLT experience grows, this technique might offer the opportunity to expand the indications of LT to patients with advanced HCC. Therefore, since LDLT is not competing for deceased donor organs, many patients with extended criteria HCC who could still benefit from transplantation may have access to this treatment option. In this review, we will discuss the role of LDLT for patients with advanced-stage HCC and how LDLT allows for safe expansion of HCC transplant criteria.

Surgical approach to achieve R0 resections in primary and metastatic liver tumors: a literature review

“…In the presence of tumor thrombosis, consideration for surgical resection is usually based on its extension. Currently, Cheng's classification of PV tumor thrombosis and The Japanese Vp-PV invasion-classification of PV tumor thrombosis classification are widely used to determine the best surgical approach (17,18). For primary tumors, tumor thrombosis of the PV is usually seen in ~40% of HCC patients (17).…”

“…In addition, it has been used with varying degrees of success for HCC, CRLM, and metastatic neuroendocrine tumors (59). Recently, efforts have been towards implementation of LT in patients with advanced HCC and unresectable CRLM (18,(60)(61)(62)(63). The SECA-II arm D study evaluated survival of 10 patients with unresectable CRLM after LT using extended criteria for patients and donors.…”