Optimal Liver Transplantation Criteria for Hepatocellular Carcinoma

LT continues to be the optimal treatment for HCC. Considerations for LT among this patient population must take into consideration organ demand and supply, as well as tumor progression with risk of recurrence post-LT. In the United States, Milan (and UNOS-DS for those beyond Milan) criteria have been used to maximize the num-ber of years gained by LT versus by alternative treatments. Advances in LRT have allowed us to downstage patients to within Milan criteria with newer pre-LT selection criteria incorporating dynamic and additional biomarkers as well as imaging modality to risk-stratify patients as we continue to look for the optimal LT cutoff for patients with HCC. Although it is impossible to compare all the LT selection models, the optimal LT criteria should be transplant-center specific, accounting for organ availability (DDLT versus LLDT) and dynamic response to LRT.

Automated summary

Liver transplantation (LT) remains the optimal treatment for hepatocellular carcinoma (HCC), but considerations must be given to organ availability and risk of recurrence. In the United States, Milan criteria have been used to maximize the benefit of LT compared to alternative treatments. Advances in local regional therapy (LRT) have allowed us to downstage patients to meet Milan criteria, and newer selection criteria incorporating biomarkers and imaging are being developed to further optimize LT for HCC patients.