Downstaging Techniques for Hepatocellular Carcinoma in Candidates Awaiting Liver Transplantation

Downstaging has been shown to be feasible for HCC within UNOS-DS criteria, with successful long-term outcomes for patients and grafts. Interventional liver-directed therapies have been the standard of care for amenable HCC lesions, and are well studied, with TACE, TARE, and ablation remaining first-line treatments for tumor control. Most recently, however, the treatment paradigm has begun to shift with the introduction of more effective systemic therapies. Immunotherapy holds promise in the downstaging setting, although further trials are warranted to assess feasibility, efficacy, and safety, as well as timing in the context of liver transplant. Until such data are produced, individual patient and center-specific expertise will likely continue to guide treatment regimens.

Automated summary

Downstaging has been shown to be feasible within UNOS-DS criteria, with successful long-term outcomes. Interventional liver-directed therapies have been the standard, but systemic therapies are becoming more effective. Immunotherapy holds promise in downstaging, but further trials are needed to assess feasibility and safety. Individual expertise will continue to guide treatment until more data is available.