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Liver transplantation for hepatocellular carcinoma

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Abstract

Over the last several years, liver transplantation has evolved to become a widely used treatment for hepatocellular carcinoma (HCC). The criteria used were developed in order to have acceptable outcomes for transplant with survival similar to other indications for transplant. These criteria are discussed in detail along with alternate options, including surgical resection and downstaging of HCC in cirrhotics. Technical considerations of liver transplantation must be considered, and living donor liver transplant is a possibility for treatment.

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References

  1. Wertheim JA, Petrowsky H, Saab S, Kupiec-Weglinski JW, Busuttil RW (2011) Major challenges limiting liver transplantation in the united states. Am J Transplant 11(9):1773–1784

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Kim WR, Lake JR, Smith JM, et al. (2017) OPTN/SRTR 2015 annual data report: liver. Am J Transplant 17(Suppl 1):174–251

    Article  PubMed  Google Scholar 

  3. El-Serag HB (2011) Hepatocellular carcinoma. N Engl J Med. 365:1118–1127

    Article  CAS  PubMed  Google Scholar 

  4. Bruix J, Sherman M (2011) Management of hepatocellular carcinoma: an update. Hepatology 53(3):1020–1022

    Article  PubMed  PubMed Central  Google Scholar 

  5. Clavien P-A, Lesurtel M, Bossuyt PMM, et al. (2012) Recommendations for liver transplantation for hepatocellular carcinoma: an international consensus conference report. Lancet Oncol 13(1):e11–e22

    Article  PubMed  Google Scholar 

  6. Forner A, Reig ME, de Lope CR, Bruix J (2010) Current strategy for staging and treatment: the BCLC update and future prospects. Semin Liver Dis 30:61–74

    Article  CAS  PubMed  Google Scholar 

  7. American Liver Tumor Study Group (1998) A randomized prospective multi-institutional trial of orthotopic liver transplantation or partial hepatic resection with or without adjuvant chemotherapy for hepatocellular carcinoma. Investigators Booklet and Protocol Richmond. Richmond: Va United Network for Organ Sharing

    Google Scholar 

  8. Ringe B, Wittekind C, Bechstein WO, Bunzendahl H, Pichlmayr R (1989) The role of liver transplantation in hepatobiliary malignancy. A retrospective analysis of 95 patients with particular regard to tumor stage and recurrence. Ann Surg 209(1):88–98

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Adham M, Oussoultzoglou E, Ducerf C, et al. (1998) Results of orthotopic liver transplantation for liver cirrhosis in the presence of incidental and/or undetected hepatocellular carcinoma and tumour characteristics. Transplant Int 11:S197–S200

    Article  Google Scholar 

  10. Mazzaferro V, Regalia E, Doci R, et al. (1996) Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med 334(11):693–699

    Article  CAS  PubMed  Google Scholar 

  11. Mazzaferro V, Bhoori S, Sposito C, et al. (2011) Milan criteria in liver transplantation for hepatocellular carcinoma: an evidence-based analysis of 15 years of experience. Liver Transplant 17(supplement 2):S44–S57

    Article  Google Scholar 

  12. Hemming AW, Cattral MS, Reed AI, et al. (2001) Liver transplantation for hepatocellular carcinoma. Ann Surg 233(5):652–659

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Leung JY, Zhu AX, Gordon FD, et al. (2004) Liver transplantation outcomes for early-stage hepatocellular carcinoma: results of a multicenter study. Liver Transplant 10(11):1343–1354

    Article  Google Scholar 

  14. Yao FY, Xiao L, Bass NM, et al. (2007) Liver transplantation for hepatocellular carcinoma: validation of the UCSF-expanded criteria based on preoperative imaging. Am J Transplant 7:2587–2596

    Article  CAS  PubMed  Google Scholar 

  15. Yao FY, Ferrell L, Bass NM, et al. (2001) Liver transplantation for hepatocellular carcinoma: expansion of the tumor size limits does not adversely impact survival. Hepatology 33(6):1394–1403

    Article  CAS  PubMed  Google Scholar 

  16. Bhardwaj N, Perera MTPR, Silva MA (2016) Current treatment approaches to HCC with a special consideration to transplantation. J Transplant 2016:7926264

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Duffy JP, Vardanian A, Benjamin E, et al. (2007) Liver transplantation criteria for hepatocellular carcinoma should be expanded: a 22-year experience with 467 patients at UCLA. Ann Surg 246(3):502–509 (discussion 509–11)

    Article  PubMed  PubMed Central  Google Scholar 

  18. Kamath PS, Wiesner RH, Malinchoc M, et al. (2001) A model to predict survival in patients with end-stage liver disease. Hepatology 33(2):464–470

    Article  CAS  PubMed  Google Scholar 

  19. https://optn.transplant.hrsa.gov/media/1200/optn_policies.pdf

  20. Sharma P, Balan V, Hernandez JL, et al. (2004) Liver transplantation for hepatocellular carcinoma: the MELD impact. Liver Transplant 10(1):36–41

    Article  Google Scholar 

  21. Sharma P, Harper AM, Hernandez JL, et al. (2006) Reduced priority MELD score for hepatocellular carcinoma does not adversely impact candidate survival awaiting liver transplantation. Am J Transplant 6(8):1957–1962

    Article  CAS  PubMed  Google Scholar 

  22. Levi DM, Tzakis AG, Martin P, et al. (2010) Liver transplantation for hepatocellular carcinoma in the model for end-stage liver disease era. J Am Coll Surg 210(5):727–734

    Article  PubMed  Google Scholar 

  23. Dutkowski P, Linecker M, DeOliveira ML, Müllhaupt B, Clavien PA (2015) Challenges to liver transplantation and strategies to improve outcomes. Gastroenterology 148:307–323

    Article  PubMed  Google Scholar 

  24. https://optn.transplant.hrsa.gov/news/revised-liver-policy-regarding-hcc-exception-scores/. Accessed 20 Feb 2017

  25. Iwatsuki S, Starzl TE, Sheahan DG, et al. (1991) Hepatic resection versus transplantation for hepatocellular carcinoma. Ann. Surg. 214(3):221–228 (discussion 228–9)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Bigourdan J-M, Jaeck D, Meyer N, et al. (2003) Small hepatocellular carcinoma in Child A cirrhotic patients: hepatic resection versus transplantation. Liver Transplant 9:513–520

    Article  Google Scholar 

  27. Vitale A, Huo T, Cucchetti A, et al. (2015) Survival benefit of liver transplantation versus resection for hepatocellular carcinoma: impact of MELD score. Ann Surg Oncol 22:1901

    Article  PubMed  Google Scholar 

  28. Proneth A, Zeman F, Schlitt HJ, Schnitzbauer AA (2014) Is resection or transplantation the ideal treatment in patients with hepatocellular carcinoma in cirrhosis if both are possible? A systematic review and metaanalysis. Ann Surg Oncol 21(9):3096–3107

    Article  PubMed  Google Scholar 

  29. Adam R, Azoulay D, Castaing D, et al. (2003) Liver resection as a bridge to transplantation for hepatocellular carcinoma on cirrhosis: a reasonable strategy? Ann Surg 238(4):508–519

    PubMed  PubMed Central  Google Scholar 

  30. Nathan H, Bridges JFP, Schulick RD, et al. (2011) Understanding surgical decision making in early hepatocellular carcinoma. J Clin Oncol 29(6):619–625

    Article  PubMed  PubMed Central  Google Scholar 

  31. Kadry Z, Schaefer EW, Uemura T, et al. (2012) Impact of geographic disparity on liver allocation for hepatocellular cancer in the United States. J Hepatol 56:618–625

    Article  PubMed  Google Scholar 

  32. Zaydfudim VM, Vachharajani N, Klintmalm GB, et al. (2016) Liver resection and transplantation for patients with hepatocellular carcinoma beyond Milan criteria. Ann Surg 264(4):650–658

    Article  PubMed  PubMed Central  Google Scholar 

  33. Ravaioli M, Grazi GL, Piscaglia F, et al. (2008) Liver transplantation for hepatocellular carcinoma: results of down-staging in patients initially outside the Milan selection criteria. Am J Transplant 8(12):2547–2557

    Article  CAS  PubMed  Google Scholar 

  34. Yao FY, Kerlan RK, Hirose R, et al. (2008) Excellent outcome following down-staging of hepatocellular carcinoma prior to liver transplantation: an intention-to-treat analysis. Hepatology 48(3):819–827

    Article  PubMed  PubMed Central  Google Scholar 

  35. Chapman WC, Majella Doyle M MB, Stuart JE, et al. (2008) Outcomes of neoadjuvant transarterial chemoembolization to downstage hepatocellular carcinoma before liver transplantation. Ann Surg 248(4):617–624

    PubMed  Google Scholar 

  36. WC Chapman, Sandra Garcia-Aroz, Neeta Vachharajani, Kathryn Fowler, Nael Saad, Yiing Lin, Jason Wellen, Benjamin Tan, Adeel S. Khan, Majella Doyle Liver Transplantation for Advanced Hepatocellular Carcinoma after Downstaging Without Up-Front Stage Restrictions. Journal of the American College of Surgeons. Available online 6 January 2017.

  37. Lo C (2008) Downstaging of hepatocellular carcinoma before transplantation: an advance in therapy or just another selection criterion. Am J Transplant 8:2485–2486

    Article  PubMed  Google Scholar 

  38. Yao FY, Mehta N, Flemming J, et al. (2015) Downstaging of hepatocellular cancer before liver transplant: long-term outcome compared to tumors within milan criteria. Hepatology 61(6):1968–1977

    Article  PubMed  PubMed Central  Google Scholar 

  39. Mangus RS, Fridell JA, Vianna RM, et al. (2008) Use of the piggyback hepatectomy technique in liver transplant recipients with hepatocellular carcinoma. Transplantation. 85(10):1496–1499

    Article  PubMed  Google Scholar 

  40. Lee L, Foley D (2016) Technical aspects of orthotopic liver transplantation for hepatocellular carcinoma. Surg Clin North Am 96(2):269–281

    Article  PubMed  Google Scholar 

  41. Bekker J, Ploem S, de Jong KP (2009) Early hepatic artery thrombosis after liver transplantation: a systematic review of the incidence, outcome and risk factors. Am J Transplant 9:746–757

    Article  CAS  PubMed  Google Scholar 

  42. Panaro F, Ramos J, Gallix B, et al. (2014) Hepatic artery complications following liver transplantation. Does preoperative chemoembolization impact the postoperative course? Clin Transplant 28:598–605

    Article  PubMed  Google Scholar 

  43. Goel A, Mehta N, Guy J, et al. (2014) Hepatic artery and biliary complications in liver transplant recipients undergoing pretransplant transarterial chemoembolization. Liver Transplant 20(10):1221–1228

    Article  Google Scholar 

  44. Richard HM III, Silberzweig JE, Mitty HA, et al. (2000) Hepatic arterial complications in liver transplant recipients treated with pretransplantation chemoembolization for hepatocellular carcinoma. Radiology 214:775–779

    Article  PubMed  Google Scholar 

  45. Wang P, Pu Y, Li H, et al. (2016) Prognosis for recipients with hepatocellular carcinoma of salvage liver transplantation versus those of primary liver transplantation: a retrospective single-center study. SpringerPlus 5(1):1809

    Article  PubMed  PubMed Central  Google Scholar 

  46. Dai WC, Chan SC, Chok KSH, et al. (2014) Good longterm survival after primary living donor liver transplantation for solitary hepatocellular carcinomas up to 8 cm in diameter. HPB 16(8):749–757

    Article  PubMed  PubMed Central  Google Scholar 

  47. Grant D, Fisher RA, Abecassis M, et al. (2011) Should the liver transplant criteria for hepatocellular carcinoma be different for deceased donation and living donation? Liver Transplant 17:S133–S138

    Article  Google Scholar 

  48. Marsh JW, Gray E, Ness R, Starzl TE (2009) Complications of right lobe living donor liver transplantation. J Hepatol 51(4):715–724

    Article  PubMed  PubMed Central  Google Scholar 

  49. Freise CE, Gillespie BW, Koffron AJ, et al. (2008) Recipient morbidity after living and deceased donor liver transplantation: findings from the A2ALL Retrospective Cohort Study. Am J Transplant 8(12):2569–2579

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. Ratner LE, Sandoval PR (2010) When disaster strikes: death of a living organ donor. Am J Transplant 10(12):2577–2581

    Article  CAS  PubMed  Google Scholar 

  51. Lauterio A, Di Sandro S, Gruttadauria S, et al. (2016) Donor safety in living donor liver donation: an Italian multicenter survey. Liver Transplant 23:184–193

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, University of California, San Diego, 9300 Campus Point Dr, MC 7745, La Jolla, CA, 92037, USA

    Jennifer Berumen & Alan Hemming

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  1. Jennifer Berumen
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  2. Alan Hemming
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Correspondence to Jennifer Berumen.

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Berumen, J., Hemming, A. Liver transplantation for hepatocellular carcinoma. Abdom Radiol 43, 185–192 (2018). https://doi.org/10.1007/s00261-017-1217-1

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