Strategies to improve outcome of patients withhepatocellular carcinoma receiving a liver transplantation

• Published in: 世界肝病学杂志：英文版（电子版） 2015 (4), p.649-661
• Main Author: Marta Guerrero-Misas,Marta Guerrero-Misas Manuel Rodríguez-Perálvarez Manuel De la Mata
• Format: Article
• Language: English
• Subjects: carcinoma; criteria; Hepatocellular; Immunosuppression; Liver; Milan; Recurrence; Bridging; therapy; transplantation
• ISSN: 1948-5182; 1948-5182

Liver transplantation is the only therapeutic option whichallows to treat both, the hepatocellular carcinoma andthe underlying liver disease. Indeed, liver transplantationis considered the standard of care for a subset ofpatients with cirrhosis and hepatocellular carcinoma.However, tumour recurrence rates are as high as 20%,and once the recurrence is established the therapeuticoptions are scarce and with little impact on prognosis.Strategies to minimize tumour recurrence and thus toimprove outcome may be classified into 3 groups （1） Anadequate selection of candidates for liver transplantationby using the Milan criteria; （2） An optimized managementwithin waiting list including prioritization of patients athigh risk of tumour progression, and the implementationof bridging therapies, particularly when the expectedlength within the waiting list is longer than 6 mo; and（3） Tailored immunosuppression comprising reducedexposure to calcineurin inhibitors, particularly early afterliver transplantation, and the addition of mammaliantarget of rapamycin inhibitors. In the present manuscriptthe available scientific evidence supporting thesestrategies is comprehensively reviewed, and futuredirections are provided for novel research approaches,which may contribute to the final target： to cure morepatients with hepatocellular carcinoma and with animproved long term outcome.