scholarly journals Oncological feasibility of liver transplantation for hepatocellular carcinoma

2020 ◽  
Vol 25 (2) ◽  
pp. 77-85
Author(s):  
D. Ju. Efimov ◽  
A. E. Shcherba ◽  
S. V. Korotkov ◽  
O. O. Rummo
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
San Francisco ◽  
Intermediate Stage ◽  
Waiting List ◽  
University Of California ◽  
Locoregional Therapy ◽  
Milan Criteria ◽  
Serological Response ◽  
One Year

Aim. To evaluate the effectiveness of the liver transplantation in patients with hepatocellular carcinoma and cirrhosis according to morphological (Milan criteria) and oncological criteria.Materials and methods. A retrospective cohort study of 105 recipients with hepatocellular carcinoma who underwent liver transplantation from 2008 to 2019 was performed. The patients were divided into 3 groups. In the 1st group, transplantation was performed according to the Milan criteria (“Milan”), in the 2nd group – to recipients that did not meet the Milan and University of California San Francisco (UCSF) criteria (“extra-UCSF”), in the 3rd group – to the recipients meeting the Barcelona Clinic Liver Cancer criteria B (Intermediate stage), subjected to locoregional therapy and assessment of radiological and serological response (“Lerut”). The frequency of progression in the waiting list, the frequency of tumor recurrence after transplantation, hospital mortality, the frequency of arterial and biliary complications, and cancer-associated mortality were studied.Results. The highest rate of hepatocellular carcinoma progression on the waiting list was observed in the “extra University of California San Francisco” group of patients (36% versus 11% (p = 0.03) and 15% (p = 0.1) in the “Milan” and “Lerut” groups, respectively). The worst cancer-associated mortality rates were found in the extraUniversity of California San Francisco group. The one-year, three-year and five-year overall survival rate in the groups were 87.5%; 80.1% and 70.3% for the Milan group; 78.6%; 62.9% and 62.9% for the extra-University of California San Francisco group and 96.4%; 86.4% and 78.7% for the Lerut group, respectively.Conclusion. The oncological prognosis for patients with hepatocellular carcinoma is formed increasingly on the basis of the biological characteristics of the tumor. The use of locoregional therapy for hepatocellular carcinoma combines a therapeutic component that allows for better survival and stratification, which allows patients with an unfavorable prognosis to be selected and to allow patients beyond the accepted criteria to expect transplantation.

scholarly journals Clinical efficacy of locoregional therapy prior to living donor liver transplantation for hepatocellular carcinoma based on UCSF criteria

2019 ◽  
Author(s):  
Tsung-Han Wu ◽  
Chih-Hsien Cheng ◽  
Chen-Fang Lee ◽  
Ting-Jung Wu ◽  
Hong-Shiue Chou ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
San Francisco ◽  
Living Donor ◽  
Living Donor Liver Transplantation ◽  
Locoregional Therapy ◽  
Donor Liver ◽  
Donor Liver Transplantation ◽  
Regional Therapy ◽  
Ucsf Criteria

Abstract Background The study analyzed the loco-regional therapy outcomes prior to living donor liver transplantation (LDLT), to provide additional information for decision-making regarding therapeutic strategy for hepatocellular carcinoma (HCC) patients. Methods A total of 308 consecutive patients undergoing LDLTs for HCC between August 2004 and December 2018 were retrospectively analyzed. Patients subjected to loco-regional therapy prior to LT were grouped and the outcomes were compared. Results Overall, HCC recurrence after LDLT were detected in 38 patients (12.3%) during the follow-up period. By the end of the study, 205 patients, 6 of whom with recurrent HCC, were alive. Patients who had radiological imaging beyond the University of California at San Francisco (UCSF) criteria had significant inferior outcomes for both recurrence-free survival (RFS, p = 0.0005) and overall survival (OS, p = 0.0462) despite receiving loco-regional therapy as down-staging intention. Moreover, patients with profound tumor necrosis (TN) had a superior RFS at 3 and 5 years (97.4% and 93.8%, respectively), compared with others. Conclusion LDLT gains a satisfactory result based on the expanded UCSF criteria for HCC. However, the loco-regional therapy prior to LDLT does not seem to provide benefit unless a profound TN is noted.

scholarly journals Outcomes of Liver Transplantation for Hepatocellular Carcinoma Beyond the University of California San Francisco Criteria

2020 ◽  
Vol 104 (1) ◽  
pp. 113-121 ◽  
Author(s):  
David W. Victor ◽  
Howard P. Monsour ◽  
Maha Boktour ◽  
Keri Lunsford ◽  
Julius Balogh ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
San Francisco ◽  
University Of California ◽  
The University

Liver Transplantation for Locally Advanced Hepatocellular Carcinoma

2020 ◽  
Vol 04 (01) ◽  
pp. 003-012
Author(s):  
Norio Kawamura ◽  
Akinobu Taketomi
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Liver Transplant ◽  
Early Stage ◽  
Locally Advanced ◽  
Tumor Biology ◽  
Locoregional Therapy ◽  
Milan Criteria ◽  
Advanced Hepatocellular Carcinoma ◽  
Advanced Hcc

AbstractSince the Milan criteria were accepted as the gold standard, liver transplantation has been widely performed as a curative treatment for early-stage hepatocellular carcinoma (HCC). The outcome of liver transplantation in early-stage HCC is excellent; however, the Milan criteria are strict, and therefore, only limited numbers of patients can benefit from liver transplantation. Many HCC patients are diagnosed at an advanced stage, which falls outside the Milan criteria, so it has been proposed over the last two decades that liver transplant surgeons should perform liver transplantation in locally advanced HCC, when presenting without recurrence. Several trials exploring the upper limits of liver transplantation have been performed, and extensive research on tumor biology has enabled the expansion of liver transplant indication for HCC. Simultaneously, locoregional therapy for advanced HCC was found to be an effective procedure when used to distinguish potentially transplantable patients. This treatment approach, known as a downstaging strategy, has been developed over the last two decades and became an essential treatment option for locally advanced HCC. In this article, the current strategies of liver transplantation for the treatment of locally advanced HCC are reviewed.

Impact of Pretransplant Bridging Locoregional Therapy for Patients With Hepatocellular Carcinoma Within Milan Criteria Undergoing Liver Transplantation

2017 ◽  
Vol 266 (3) ◽  
pp. 525-535 ◽  
Author(s):  
Vatche G. Agopian ◽  
Michael P. Harlander-Locke ◽  
Richard M. Ruiz ◽  
Goran B. Klintmalm ◽  
Srinath Senguttuvan ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Locoregional Therapy ◽  
Milan Criteria
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