Background and Aims: Morphometric features such as the Milan criteria serve as
standard criteria for liver transplantation (LT) in patients with hepatocellular carcinoma
(HCC). Since it has been recognized that these criteria are too restrictive and do not
adequately display the tumor biology, additional selection parameters are emerging.
Methods: Concise review of the current literature on patient selection for downstaging and
LT for HCC outside the Milan criteria.
Results: The major task in patients outside the Milan criteria is the need for higher granularity
with patient selection, since the benefit through LT is not uniform. The recent literature clearly
shows that beneath tumor size and number, additional selection parameters are useful in the
process of patient selection for and during downstaging. For initial patient selection, the
alpha fetoprotein (AFP) level adds additional information to the size and number of HCC
nodules concerning the chance of successful downstaging and LT. This effect is quantifiable
using newer selection tools like the WE (West-Eastern) downstaging criteria or the
Metroticket 2.0 criteria. Also an initial PET-scan and/or tumor biopsy can be helpful,
especially in the high risk group of patients outside the University of California San
Francisco (UCSF) criteria. After this entry selection, the clinical course during
downstaging procedures concerning the tumor and the AFP response is of paramount
importance and serves as an additional final selection tool
Conclusion: Selection criteria for liver transplantation in HCC patients are becoming more
and more sophisticated, but are still imperfect. The implementation of molecular
knowledge will hopefully support a more specific risk prediction for HCC patients in
the future, but do not provide a profound basis for clinical decision-making at present.
| Identifer | oai:union.ndltd.org:DRESDEN/oai:qucosa:de:qucosa:85840 |
| Date | 07 June 2023 |
| Creators | Seehofer, Daniel, Petrowsky, Henrik, Schneeberger, Stefan, Vibert, Eric, Ricke, Jens, Sapisochin, Gonzalo, Nault, Jean-Charles, Berg, Thomas |
| Publisher | Frontiers Media S.A. |
| Source Sets | Hochschulschriftenserver (HSSS) der SLUB Dresden |
| Language | English |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, doc-type:article, info:eu-repo/semantics/article, doc-type:Text |
| Rights | info:eu-repo/semantics/openAccess |
| Relation | 10333 |
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