Liver transplantation for hepatocellular carcinoma: Where do we stand?

World J Gastroenterol. 2019 Jun 7;25(21):2591-2602. doi: 10.3748/wjg.v25.i21.2591.


Hepatocellular carcinoma represents an important cause of morbidity and mortality worldwide. It is the sixth most common cancer and the fourth leading cause of cancer death. Liver transplantation is a key tool for the treatment of this disease in human therefore hepatocellular carcinoma is increasing as primary indication for grafting. Although liver transplantation represents an outstanding therapy for hepatocellular carcinoma, due to organ shortage, the careful selection and management of patients who may have a major survival benefit after grafting remains a fundamental question. In fact, only some stages of the disease seem amenable of this therapeutic option, stimulating the debate on the appropriate criteria to select candidates. In this review we focused on current criteria to select patients with hepatocellular carcinoma for liver transplantation as well as on the strategies (bridging) to avoid disease progression and exclusion from grafting during the stay on wait list. The treatments used to bring patients within acceptable criteria (down-staging), when their tumor burden exceeds the standard criteria for transplant, are also reported. Finally, we examined tumor reappearance following liver transplantation. This occurrence is estimated to be approximately 8%-20% in different studies. The possible approaches to prevent this outcome after transplant are reported with the corresponding results.

Keywords: Bridging; Down-staging; Hepatocellular carcinoma; Liver transplantation; Milan Criteria.

Publication types

  • Review

MeSH terms

  • Allografts / pathology
  • Allografts / supply & distribution
  • Carcinoma, Hepatocellular / mortality
  • Carcinoma, Hepatocellular / pathology
  • Carcinoma, Hepatocellular / therapy*
  • Disease Progression
  • Disease-Free Survival
  • Embolization, Therapeutic / methods
  • Health Care Rationing / standards
  • Humans
  • Liver / pathology
  • Liver Neoplasms / mortality
  • Liver Neoplasms / pathology
  • Liver Neoplasms / therapy*
  • Liver Transplantation / standards*
  • Medical Oncology / standards
  • Neoadjuvant Therapy / methods
  • Neoplasm Recurrence, Local / epidemiology*
  • Neoplasm Recurrence, Local / pathology
  • Neoplasm Recurrence, Local / prevention & control
  • Neoplasm Staging
  • Observational Studies as Topic
  • Patient Selection*
  • Practice Guidelines as Topic
  • Risk Factors
  • Time Factors
  • Waiting Lists / mortality