LIVER TRANSPLANT FOR HEPATOCELLULAR CARCINOMA. OPTIMAL PREOPERATIVE MANAGEMENT.
Keywords:hepatocellular carcinoma, liver transplant, bridging therapy, downstaging therapy
Background: Hepatocellular carcinoma (HCC) is a major cause of morbidity and mortality worldwide. It ranks sixth among all cancers and is the fourth leading cause of death by cancer. Liver transplant is a key way of treating this disease, therefore, hepatocellular carcinoma grows as a primary indication for graft allocation. Although, liver transplant is a remarkable therapy for hepatocellular carcinoma, organ deficiency, as well as careful selection and management of patients who may have a major survival benefit after the transplant, remains a fundamental question. In fact, HCC is susceptible to transplantation only in some stages of the disease, which provokes discussions about the appropriate criteria for candidates’ selection. In this article, we focused on the current criteria for selecting patients with hepatocellular carcinoma, eligible for liver transplant, as well as strategies to prevent disease progression and the exclusion of candidates from the waiting list, using specific treatments used to reduce the stage of the disease and obtain acceptable criteria for transplantation ("downstaging"), when their tumor burden exceeds standard transplant criteria. Finally, we examined tumor recurrence after liver transplantation. We examined the occurrence of relapse, which is estimated to be about 8-20%, and possible approaches to prevent the recurrence of the disease after liver transplant, that are reported with appropriate results.
Conclusions: Although, there is a clear growing interest in admitting patients with larger tumors for liver transplant, the Milan criteria remains essential in selecting patients with HCC for transplant. Bridging and tumor downstaging therapies are helpful in reducing the abandonment of patients awaiting liver transplant.
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