Liver Transplantation for Hepatoma: Raising the Bar

AbstractPurpose of ReviewEver since the birth of liver transplantation, cancer has played a major role in the advances to the field. With improved outcomes came increasing demands on a limited organ supply and the need for policy development to guide organ allocation. This is an attempt to summarize important milestones in the practice and policy developments over the past 50  years with a nod to our collective ability to continue to improve the field of transplantation, care of liver cancer, and value of that gift of life—the donor liver.Recent FindingsThe most recent Organ Procurement and Transplantation Network (OPTN) Policy changes further improve liver allocation to cancer candidates with a focus on (1) current hepatocellular cancer (HCC) size and number, (2) downstaging criteria, and (3) AFP limits and will help to better achieve equitable allocation of livers to HCC and non-HCC candidates needing transplantation using objective real-time evidence to base our practice.SummaryWe, as a community have and despite our individual needs and patterns, have shown how data collection, review, and discussion can lead to best practice at a grand scale. From its first days as a procedure to our current state of expertise, liver transplantation for HCC remains a classic example of evidence-based practice.
Source: Current Transplantation Reports - Category: Transplant Surgery Source Type: research

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The ultimate goal of locoregional therapy (LRT) to the liver is to induce total tumor necrosis. Trans-arterial chemoembolization (TACE) is the mainstay bridging therapy for patients with hepatocellular carcino...
Source: BMC Cancer - Category: Cancer & Oncology Authors: Tags: Research article Source Type: research
Conclusion: The ΔMoRAL after the first TACE, a simple and objective index, provides refined prognostication for patients with intermediate-stage HCC. Proceeding to a second TACE may not provide additional survival benefits in cases of a MoRAL-increase after the first TACE in patients with a high baseline MoRAL score (≥89.5), who might be candidates for systemic therapy.
Source: Cancers - Category: Cancer & Oncology Authors: Tags: Article Source Type: research
annon Glaser Liver cancer is a devastating cancer that ranges from relatively rare (around 2% of all cancers in the United States) to commonplace (up to 50% of cancers in underdeveloped countries). Depending upon the stage of pathogenesis, prognosis, or functional liver tissue present, transplantation or partial hepatectomy may be the only available treatment option. However, due to the rise in metabolic syndrome and the increasing demand for livers, patients often wait months or years for available organs. Due to this shortage, doctors must have other treatment options available. One promising area of cancer research ...
Source: Cancers - Category: Cancer & Oncology Authors: Tags: Review Source Type: research
Abstract BACKGROUND: Tumor recurrence after orthotopic liver transplantation (OLT) remains a serious threat for long-term survival of the recipients with hepatocellular carcinoma (HCC), since very few factors or measures have shown impact on overcoming HCC recurrence after OLT. Postoperative infection suppresses tumor recurrence and improves patient survival in lung cancer and malignant glioma probably via stimulating the immune system. Post-transplant infection (PTI), a common complication, is deemed to be harmful for the liver transplant recipients from a short-term perspective. Nevertheless, whether PTI inhibit...
Source: World Journal of Gastroenterology : WJG - Category: Gastroenterology Authors: Tags: World J Gastroenterol Source Type: research
Authors: Saitta C, Pollicino T, Raimondo G Abstract Obesity prevalence is rapidly increasing worldwide. It is associated with huge economic and health costs due to its clinical consequences, which includes increased incidence of type 2 diabetes, cardiovascular diseases, and development of different malignancies. In particular, obesity is an independent risk factor for the development of hepatocellular carcinoma (HCC). Indeed, obesity is highly prevalent in patients with non-alcoholic fatty liver disease (NAFLD) that is becoming one of the most frequent causes of liver disease worldwide. NAFLD-related HCC is the mos...
Source: Annals of Hepatology - Category: Gastroenterology Tags: Ann Hepatol Source Type: research
Hepatocellular carcinoma (HCC) is the most common primary liver tumor and the 3rd leading cause of cancer-related deaths worldwide [1,2]. When feasible, curative options such as liver transplantation (LT) and resection represent the treatment of choice as they offer long term survival [3,4]. HCC occurs primarily in patients with underlying liver disease, negatively affecting prognosis and increasing the complexity of treatment [5,6]; liver cirrhosis, in fact, is an independent prognostic factor for both short and long-term outcomes, and the assessment of liver function remains critical in the management of HCC patients as ...
Source: Journal of Hepatology - Category: Gastroenterology Authors: Source Type: research
We read with great interest the recent review by Tschuor et al.1 reviewing the allocation policies of liver grafts worldwide. The authors should be congratulated on their hard work on this very important document. However, the description of allocation policies for liver cancer in liver transplantation in Canada and the number of liver transplants performed are not completely accurate and as such, we would like to clarify the details.
Source: Journal of Hepatology - Category: Gastroenterology Authors: Tags: Letter to the Editor Source Type: research
Conclusions: The MoRAL score provides the most refined prognostication for predicting HCC recurrence after LDLT.
Source: Cancers - Category: Cancer & Oncology Authors: Tags: Article Source Type: research
Hepatocellular carcinoma and intrahepatic cholangiocarcinoma are often amenable to locoregional therapy, including percutaneous ablation, transarterial chemoembolization (TACE), or transarterial radioembolization (TARE). TARE is a technique that delivers a high dose of radiation to the tumor, while limiting the dose to the normal liver parenchyma and the adjacent organs. It has been shown to effectively provide disease control with relatively few toxicities, and in certain cases results in a complete response. It is the preferred therapy as a bridge to liver transplant and can provide necessary compensatory future liver re...
Source: Surgical Oncology Clinics of North America - Category: Surgery Authors: Source Type: research
Abstract Liver cancers are the second most frequent cause of global cancer-related mortality of which 90% are attributable to hepatocellular carcinoma (HCC). Despite the advent of screening programmes for patients with known risk factors, a substantial number of patients are ineligible for curative surgery at presentation with limited outcomes achievable with systemic chemotherapy/external radiotherapy. This has led to the advent of numerous minimally invasive options including but not limited to trans-arterial chemoembolization, radiofrequency/microwave ablation and more recently selective internal radiation ther...
Source: World Journal of Gastroenterology : WJG - Category: Gastroenterology Authors: Tags: World J Gastroenterol Source Type: research
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