title: Current challenges in liver transplantation for hepatocellular carcinoma.
abstract: Liver transplantation (LT) is the best option of cure for hepatocellular carcinoma (HCC). Notwithstanding several alternatives, Milan Criteria remain the cornerstone for patient selection. Currently, expanded criteria patients are unsuitable for LT without taking downstaging approaches and response to therapies into consideration. Relative weight of HCC as indication to LT is increasing and that generates competition with MELD-described non-cancer indications. Allocation policies should be adjusted accordingly, considering principles of urgency and utility in the management of the waiting list and including transplant benefit to craft equitable criteria to deal with the limited resource of donated grafts. Maximization of cost-effectiveness of LT in HCC can be also pursued through changes in immunosuppression policies and multimodal management of post-transplant recurrences. This review is focused on those constantly mutating challenges that have to be faced by anyone dealing with the management of HCC in the context of liver transplantation.
authors.affiliation: Gastroenterology, Surgery and Liver Transplantation Unit, Fondazione Istituto Nazionale Tumori IRCCS, National Cancer Institute, Via Venezian 1, Milan 20133, Italy.
authors.forename: Sherrie
authors.initials: S
authors.lastname: Bhoori
authors.affiliation: Gastroenterology, Surgery and Liver Transplantation Unit, Fondazione Istituto Nazionale Tumori IRCCS, National Cancer Institute, Via Venezian 1, Milan 20133, Italy. Electronic address: vincenzo.mazzaferro@istitutotumori.mi.it.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Mazzaferro
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation; D018579:Patient Selection; D040841:Resource Allocation; D014850:Waiting Lists
keywords: Allocation; Bridging; Downstaging; Hepatocellular carcinoma; Immunosuppression; Liver transplantation; Patient selection; Post-transplantation recurrence