Response to Therapy as a Criterion for Awarding Priority to Patients With Hepatocellular Carcinoma Awaiting Liver Transplantation

Abstract

Response to therapy is a potentially effective tool for prioritizing HCC patients for LT.

A Multistep, Consensus-Based Approach to Organ Allocation in Liver Transplantation: Toward a “Blended Principle Model”

“…Either conventional (Milan criteria) or extended criteria (e.g., up to 7, total tumor volume, UCSF, a fetoprotein model) (9,14-16) may therefore be used to characterize a tumor as TT (9,14,17). Patients thus defined as TT were then classified using more dynamic categories (Table 3): first presentation, early or late recurrence, type of response to bridging therapy, successful downstaging.…”

“…Accurate benefit prognosticators are lacking, so the feasibility of other treatments, response to therapy, and successful downstaging were considered as surrogates (17,31,32). It was agreed that the benefit for patients with very early HCC in compensated cirrhosis, or HCC patients with other radical therapeutic options (such as liver resection) is intrinsically too low to warrant their prioritization for transplantation, whereas impaired liver function in HCC patients substantially increases the potential transplant benefit because it limits the alternative treatment options (5).…”

Liver Transplantation is a Preferable Alternative to Palliative Therapy for Selected Patients with Advanced Hepatocellular Carcinoma

“…In a recent study from the USCF group, AFP ≥500ng/ml and rapid tumor progression predicted dropout even in patients with very early stage HCC (single tumor <2cm) [31]. In another study, which included patients with HCC within and beyond Milan, the response to therapy was the only predictor of dropout, irrespective of tumor staging [32]. Likewise, a high AFP levels, but not total tumor volume was associated with waiting list dropout [33].…”

Current advances made in the surgical treatment of hepatocellular carcinoma

“…Different models have been developed to quantify the risk of death in neoplastic and nonneoplastic patients. 89,92 As the neoplastic risk assessment is not considered in MELD scoring, patients with unresectable HCC within the MC have been considered exceptions in the American allocation system. Patients with HCC fulfilling the MC enter the waiting list with a MELD score equal to 22 and receive incremental points for every three months spent on the waiting list.…”