title: Liver transplantation for hepatocellular carcinoma: role of inflammatory and immunological state on recurrence and prognosis.
abstract: Criteria for liver transplantation (LT) for hepatocellular carcinoma (HCC) and post-LT indicators of prognosis are historically based on the measurement of the tumor mass. Recently, high throughput technologies have increased the prediction of recurrence, but these tools are not yet routinely available. The interaction between HCC and the immune system has revealed an imbalance of lymphocyte phenotypes in the peritumoral tissue, and the increase of regulatory T cells with respect to cytotoxic lymphocytes has been linked to a higher rate of post-LT HCC recurrence. Moreover, some inflammatory markers have shown good reliability in predicting cancer reappearance after surgery, as a result of either a systemic inflammatory response or a decreased capacity of the organism to control the tumor growth. Among these markers, the neutrophil-to-lymphocyte ratio appears to be the most promising and easily available serum parameter able to predict HCC recurrence after LT and following other types of treatment, although the exact mechanisms determining its elevation have not been clarified. Post-LT immunosuppression may impact on cancer control, and the exposure to high levels of calcineurin inhibitors or other immunosuppressants has recently emerged as a negative prognostic factor for HCC recurrence and patient survival. Despite the absence of prospective randomized trials, inhibitors of the mammalian target of rapamycin have been shown to be associated with lower rates of tumor recurrence compared to other immunosuppressors, suggesting their use especially in patients with HCC exceeding the conventional indication criteria for LT.
authors.affiliation: Matteo Cescon, Valentina Rosa Bertuzzo, Giorgio Ercolani, Matteo Ravaioli, Federica Odaldi, Antonio Daniele Pinna, General Surgery and Transplant Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, 40138 Bologna, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Cescon
authors.affiliation: Matteo Cescon, Valentina Rosa Bertuzzo, Giorgio Ercolani, Matteo Ravaioli, Federica Odaldi, Antonio Daniele Pinna, General Surgery and Transplant Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, 40138 Bologna, Italy.
authors.forename: Valentina Rosa
authors.initials: VR
authors.lastname: Bertuzzo
authors.affiliation: Matteo Cescon, Valentina Rosa Bertuzzo, Giorgio Ercolani, Matteo Ravaioli, Federica Odaldi, Antonio Daniele Pinna, General Surgery and Transplant Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, 40138 Bologna, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Ercolani
authors.affiliation: Matteo Cescon, Valentina Rosa Bertuzzo, Giorgio Ercolani, Matteo Ravaioli, Federica Odaldi, Antonio Daniele Pinna, General Surgery and Transplant Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, 40138 Bologna, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Ravaioli
authors.affiliation: Matteo Cescon, Valentina Rosa Bertuzzo, Giorgio Ercolani, Matteo Ravaioli, Federica Odaldi, Antonio Daniele Pinna, General Surgery and Transplant Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, 40138 Bologna, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Odaldi
authors.affiliation: Matteo Cescon, Valentina Rosa Bertuzzo, Giorgio Ercolani, Matteo Ravaioli, Federica Odaldi, Antonio Daniele Pinna, General Surgery and Transplant Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, 40138 Bologna, Italy.
authors.forename: Antonio Daniele
authors.initials: AD
authors.lastname: Pinna
mesh_terms: D014408:Biomarkers, Tumor / Q000097:blood*; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000276:immunology / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D007249:Inflammation / Q000097:blood / Q000276:immunology* / Q000401:mortality; D018836:Inflammation Mediators / Q000097:blood*; D008113:Liver Neoplasms / Q000097:blood / Q000276:immunology / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D016246:Lymphocytes, Tumor-Infiltrating / Q000276:immunology*; D009364:Neoplasm Recurrence, Local; D009504:Neutrophils / Q000276:immunology; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor; D007166:Immunosuppressive Agents; D018836:Inflammation Mediators
keywords: Hepatocellular carcinoma; Immunosuppression; Inflammation; Liver transplantation; Recurrence