Hepatocellular carcinoma – time to take the ticket

Table 1 Modified UCSF down-staging criteria

Inclusion criteria

a) 1 lesion > 5 cm and ≤ 8 cm

b) 2 or 3 lesions, at least one > 3 cm but ≤ 5 cm + the total tumor diameter ≤ 8 cm

c) 4 or 5 lesions, all ≤ 3 cm + the total tumor diameter ≤ 8 cm

d) No vascular invasion on imaging

Criteria for successful down-staging

Tumor size and number need to satisfy the UNOS T2 criteria

Complete tumor necrosis without contrast enhancement to suggest residual tumor, equivalent to obliteration of the tumor irrespective of the tumor size

Additional guidelines

1) A minimum observation period of 3 mo after down-staging is required before deceased donor liver transplantation, and if imaging studies meet the above-mentioned criteria for successful down-staging

2) Patients can undergo live donor liver transplantation at 3 mo after down-staging, and if imaging studies satisfy the UCSF criteria

3) Those with acute hepatic decompensation after the down-staging procedure are not eligible for liver transplantation unless they satisfy the abovementioned criteria