Treatment of HCC in patients awaiting liver transplantation

M. Schwartz, S. Roayaie, P. Uva

Research output: Contribution to journalShort surveypeer-review

63 Scopus citations

Abstract

Liver transplantation (LT) is the treatment of choice for many patients with unresectable hepatocellular carcinoma (HCC), but long waiting time due to the shortage of donor organs can result in tumor progression and drop-out from LT candidacy. Furthermore, even in candidates meeting the restrictive Milan criteria there is risk of HCC recurrence; this risk rises significantly when patients with more advanced HCC are included. In an effort to address these issues, treatment of HCC in patients awaiting LT has become widespread practice. In this review the various modalities employed in the pre-LT setting are presented, and the evidence for benefit with regard to (1) improvement of post-LT survival, (2) down-staging of advanced HCC to within Milan criteria and (3) preventing waiting list drop-out is considered. Chemoembolization, radiofrequency ablation and ethanol injection all have well-documented antitumor activity; however, there is no high level evidence that waiting list HCC treatment with these modalities is effective in achieving any of the three above-mentioned aims. Nevertheless, particularly in the United States, where continued waiting list priority depends on maintaining HCC within Milan criteria, use of nonsurgical HCC treatment will likely continue in an effort to forestall tumor progression and waiting list drop-out.

Original languageEnglish
Pages (from-to)1875-1881
Number of pages7
JournalAmerican Journal of Transplantation
Volume7
Issue number8
DOIs
StatePublished - Aug 2007

Keywords

  • Hepatocellular carcinoma
  • Liver transplantation
  • Treatment
  • Waiting list

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