Review
Gastroenterology & Hepatology
Leana Frankul, Catherine Frenette
Summary: Downstaging treatment is crucial for patients with unresectable hepatocellular carcinoma who are not eligible for liver transplantation, but severe organ shortage limits its broader application. Debate over the optimal treatment protocol and assessment method for downstaging treatment is pushing the boundaries of liver transplantation candidate selection.
JOURNAL OF CLINICAL AND TRANSLATIONAL HEPATOLOGY
(2021)
Review
Oncology
Laura Crocetti, Elena Bozzi, Paola Scalise, Irene Bargellini, Giulia Lorenzoni, Davide Ghinolfi, Daniela Campani, Emanuele Balzano, Paolo De Simone, Roberto Cioni
Summary: Liver transplantation is the primary treatment for patients with unresectable early-stage hepatocellular carcinoma and cirrhosis. While traditional Milan criteria are restrictive, there is a trend towards expanding inclusion criteria due to a limited organ supply. Locoregional therapies play a crucial role in selecting patients who will benefit the most from transplantation and meet the criteria for transplantation.
Article
Oncology
Vladimir J. Lozanovski, Said Adigozalov, Elias Khajeh, Omid Ghamarnejad, Ehsan Aminizadeh, Christina Schleicher, Thilo Hackert, Beat Peter Mueller-Stich, Uta Merle, Susanne Picardi, Frederike Lund, De-Hua Chang, Markus Mieth, Hamidreza Fonouni, Mohammad Golriz, Arianeb Mehrabi
Summary: Every declined organ is a missed opportunity that increases mortality on the waiting lists. Our analysis shows that decision-making during organ allocation is not standardized and 50% of potentially suitable organs are declined. There is a need for optimized allocation protocols to avoid unnecessary organ declination and improve patient care.
Article
Gastroenterology & Hepatology
Matteo Ravaioli, Quirino Lai, Maurizio Sessa, Davide Ghinolfi, Guido Fallani, Damiano Patrono, Stefano Di Sandro, Alfonso Avolio, Federica Odaldi, Jessica Bronzoni, Francesco Tandoi, Riccardo De Carlis, Marco Maria Pascale, Gianluca Mennini, Giuliana Germinario, Massimo Rossi, Salvatore Agnes, Luciano De Carlis, Matteo Cescon, Renato Romagnoli, Paolo De Simone
Summary: Italy's policy of giving national allocation priority to patients with a model for end-stage liver disease (MELD) score ≥30 has resulted in more liver transplants, fewer dropouts, and shorter waiting times for patients with MELD ≥30. However, there is still a higher risk of graft loss in these cases. The size of transplant centers and competition among centers may play a role in recipient prioritization and outcomes.
JOURNAL OF HEPATOLOGY
(2022)
Article
Surgery
Parissa Tabrizian, Matthew L. Holzner, Neil Mehta, Karim Halazun, Vatche G. Agopian, Francis Yao, Ronald W. Busuttil, John Roberts, Jean C. Emond, Benjamin Samstein, Robert S. Brown, Marc Najjar, William C. Chapman, Majella Mb Doyle, Sander S. Florman, Myron E. Schwartz, Josep M. Llovet
Summary: This study aimed to investigate the 10-year outcomes of patients with hepatocellular carcinoma (HCC) after liver transplant (LT), particularly those who were downstaged to meet the transplant criteria. The results showed that patients who successfully downstaged their disease had better overall survival rates, validating the effectiveness of downstaging and highlighting the importance of individualized decision-making when choosing surgical management for HCC recurrence after LT.
Review
Oncology
Christos D. Kakos, Ioannis A. Ziogas, Charikleia D. Demiri, Stepan M. Esagian, Konstantinos P. Economopoulos, Dimitrios Moris, Georgios Tsoulfas, Sophoclis P. Alexopoulos
Summary: Hepatocellular carcinoma is a common primary liver cancer in children. Liver transplantation is the only potentially curative option for children with unresectable hepatocellular carcinoma, and favorable survival rates have been observed post transplantation. Further research is needed to establish appropriate selection criteria for liver transplantation in pediatric HCC.
Article
Chemistry, Medicinal
Koen G. A. M. Hussaarts, Leni van Doorn, Sander Bins, Dave Sprengers, Peter de Bruijn, Roelof W. F. van Leeuwen, Stijn L. W. Koolen, Teun van Gelder, Ron H. J. Mathijssen
Summary: The study found that sorafenib exposure decreased over time during combined treatment with immunosuppressants, and two patients also experienced declining tacrolimus plasma levels. Patients were unable to increase the sorafenib dose higher than 200 mg b.i.d. without experiencing significant toxicity.
Review
Oncology
Tsuyoshi Shimamura, Ryoichi Goto, Masaaki Watanabe, Norio Kawamura, Yasutsugu Takada
Summary: Liver transplantation is the ideal treatment for hepatocellular carcinoma, but the existing criteria are regarded as too restrictive and limit the access to transplantation. Efforts are being made to establish more reliable selection criteria, including the use of surrogate markers to evaluate the tumor's biological behavior.
Article
Surgery
Ola Ahmed, Neeta Vachharajani, Kris P. Croome, Parissa Tabrizian, Vatche Agopian, Karim Halazun, Johnny C. Hong, Leigh Anne Dageforde, William C. Chapman, Mb Majella Doyle
Summary: This study assessed liver transplantation outcomes for hepatocellular carcinoma (HCC) patients initially presenting beyond the expanded University of California San Francisco (B-eUCSF) criteria. The results showed that patients initially presenting beyond B-eUCSF criteria achieved comparable survival rates to those meeting the criteria (W-eUCSF) after transplantation.
JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS
(2022)
Article
Oncology
Jan-Paul Gundlach, Michael Linecker, Henrike Dobbermann, Felix Wadle, Thomas Becker, Felix Braun
Summary: Liver transplantation is the only definitive treatment for hepatocellular carcinoma in cirrhosis. The use of Milan-criteria and labMELD in selecting patients for transplantation has limitations. This study found that liver transplantation for patients with hepatocellular carcinoma, regardless of Milan-criteria, had comparable outcomes and cost-effectiveness. Extended criteria donor grafts were favored for patients outside the Milan-criteria with low labMELD.
Article
Medicine, General & Internal
Behnam Saberi, Ahmet Gurakar, Hani Tamim, Carolin V. Schneider, Omar T. Sims, Alan Bonder, Zachary Fricker, Saleh A. Alqahtani
Summary: This study examined the racial disparities in liver transplant and post-transplant outcomes for hepatocellular carcinoma patients in the United States. The study found that there were unequal proportions of liver transplant and differences in survival rates among different racial groups. Black or African American patients had the worst outcomes after liver transplant.
Article
Gastroenterology & Hepatology
Aline Lopes Chagas, Angelo A. Mattos, Marcio A. Diniz, Guilherme E. G. Felga, Ilka F. S. F. Boin, Rita C. M. A. Silva, Renato F. Silva, Jose H. P. Garcia, Agnaldo S. Lima, Julio C. U. Coelho, Paulo L. Bittencourt, Venancio A. F. Alves, Luiz Augusto Carneiro D'Albuquerque, Flair J. Carrilho
Summary: The study evaluated post-OLT outcomes in 1059 liver transplant recipients with HCC in Brazil, finding satisfactory overall survival and recurrence rates for patients within MC. BMC showed lower performance in predicting recurrence risk. Future discussions may involve revisiting the criteria currently used.
ANNALS OF HEPATOLOGY
(2021)
Review
Oncology
Qimeng Gao, Imran J. Anwar, Nader Abraham, Andrew S. Barbas
Summary: Immune checkpoint inhibitors have transformed the treatment of hepatocellular carcinoma, with increasing interest in using them in the neoadjuvant setting prior to liver transplantation. While liver transplant offers excellent outcomes for HCC patients, further research is needed to assess the safety and efficacy of using ICIs as bridging or downstaging therapies. Minimal washout periods between ICI use and liver transplantation are crucial factors to consider for successful transplant outcomes.
Review
Gastroenterology & Hepatology
Beat Moeckli, Pietro Majno, Lorenzo A. Orci, Andrea Peloso, Christian Toso
Summary: Liver transplantation provides the best chance of cure for early-stage hepatocellular carcinoma patients, but in Europe, multiple transplantation networks use different criteria for liver transplantation. Possible paths for future improvement include transitioning from fixed criteria to a more flexible benefit model.
SEMINARS IN LIVER DISEASE
(2021)
Review
Oncology
Gian Piero Guerrini, Giuseppe Esposito, Tiziana Olivieri, Paolo Magistri, Roberto Ballarin, Stefano Di Sandro, Fabrizio Di Benedetto
Summary: This article compares the surgical and long-term outcomes of Salvage Liver Transplantation (SLT) and Primary Liver Transplantation (PLT) for HCC through a meta-analysis. The results show that SLT has comparable surgical outcomes but slightly poorer long-term survival compared to PLT.