Clinical and Molecular Hepatology  2016;22(3):309-318

doi:10.3350/cmh.2016.0042

Liver transplantation for advanced hepatocellular carcinoma.

Hae Won LEE 1 ; Kyung Suk SUH

Affiliations

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Keywords

Carcinoma; Hepatocellular; Transplantation, Liver; Selection Criteria; Expanded criteria; Biomarker

Country

Republic of Korea

Language

English

Abstract

There has been ongoing debate that the Milan criteria may be too strict that a significant number of patients who could benefit from liver transplantation (LT) might have been excluded. Based on this idea, various studies have been conducted to further expand the Milan criteria and give more HCC patients a chance of cure. In deceased donor LT (DDLT) setting, expansion of the criteria is relatively tempered because the results of LT for HCC should be comparable to those of patients with non-malignant indications. On the other hand, in living donor LT (LDLT) situation, liver grafts are not public resources. The acceptable target outcomes for LDLT might be much lower than those for DDLT. Patients with biologically favorable tumors might have excellent survivals after LT despite morphological advanced HCCs. Therefore, the significance and utility of biological tumor parameters for selecting suitable LT candidates have been increased to predict HCC recurrence after LT. Although there is no consensus regarding the use of prognostic biomarkers in LT selection criteria for HCC, the combination of conventional morphological parameters and new promising biomarkers could help us refine and expand the LT criteria for HCC in the near future.