Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 7, 2019; 25(21): 2591-2602
Published online Jun 7, 2019. doi: 10.3748/wjg.v25.i21.2591
Liver transplantation for hepatocellular carcinoma: Where do we stand?
Francesco Santopaolo, Ilaria Lenci, Martina Milana, Tommaso Maria Manzia, Leonardo Baiocchi
Francesco Santopaolo, Ilaria Lenci, Martina Milana, Leonardo Baiocchi, Hepatology Unit, Department of Medicine, Policlinico Universitario Tor Vergata, Rome 00133, Italy
Tommaso Maria Manzia, Transplant Surgery Unit, Department of Surgery, Policlinico Universitario Tor Vergata, Rome 00133, Italy
Author contributions: Santopaolo F and Baiocchi L wrote the paper; Lenci I, Milana M, and Manzia TM collaborate with tables, retrieved references; Baiocchi L suggested the paper, elaborate table; Lenci I, Milana M, Manzia TM, and Baiocchi L revised the paper.
Conflict-of-interest statement: No potential conflicts of interest. No financial support.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Leonardo Baiocchi, MD, PhD, Assistant Professor, Hepatology Unit, Department of Medicine, Policlinico Universitario Tor Vergata, Viale Oxford 81, Rome 00133, Italy.
Telephone: +39-620902626
Received: February 28, 2019
Peer-review started: March 1, 2019
First decision: March 5, 2019
Revised: April 9, 2019
Accepted: April 29, 2019
Article in press: April 29, 2019
Published online: June 7, 2019

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: Hepatocellular carcinoma, Liver transplantation, Bridging, Down-staging, Milan Criteria

Core tip: Liver transplantation is an important tool for the treatment of hepatocellular carcinoma in human. In this review we focused on the main debated issues in this field including: (1) Criteria for candidate selection; (2) Bridging therapy to transplant; and (3) Down-staging of patients exceeding transplant criteria. Tumor recurrence rate in the graft and strategies to prevent this occurrence, are also discussed.