title: Hepatocellular carcinoma in patients listed for liver transplantation: Current and future allocation policy and management strategies for the individual patient.
abstract: Liver transplantation can provide definitive cure for patients with cirrhosis and hepatocellular carcinoma (HCC) when used appropriately. Advances in the management of HCC have allowed improved control of HCC while waiting for liver transplantation and new approaches to candidate selection particularly with regard to tumor burden and downstaging protocols. Additionally, there have been recent changes in allocation policy related to HCC in the U.S. that cap the HCC MELD exception at 34 points and implement a 6-month delay in a HCC MELD exception. This review examines the U.S. liver transplant allocation policy related to HCC, comprehensively details locoregional therapy options in HCC patients awaiting liver transplantation, and considers the impact of an increasing burden of HCC on future liver graft allocation policy.
authors.affiliation: Division of Digestive Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA.
authors.forename: Joel P
authors.initials: JP
authors.lastname: Wedd
authors.affiliation: Division of Gastroenterology and Hepatology, University of Colorado, Aurora, CO.
authors.forename: Eric
authors.initials: E
authors.lastname: Nordstrom
authors.affiliation: Department of Surgery, University of Colorado, Aurora, CO.
authors.forename: Trevor
authors.initials: T
authors.lastname: Nydam
authors.affiliation: Department of Interventional Radiology, Anschutz Medical Campus, University of Colorado, Aurora, CO.
authors.forename: Janette
authors.initials: J
authors.lastname: Durham
authors.affiliation: Department of Surgery, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Michael
authors.initials: M
authors.lastname: Zimmerman
authors.affiliation: Department of Interventional Radiology, Anschutz Medical Campus, University of Colorado, Aurora, CO.
authors.forename: Thor
authors.initials: T
authors.lastname: Johnson
authors.affiliation: Division of Medical Oncology, University of Colorado, Aurora, CO.
authors.forename: W
authors.initials: W
authors.lastname: Thomas Purcell
authors.affiliation: Division of Gastroenterology and Hepatology, University of Colorado, Aurora, CO.
authors.forename: Scott W
authors.initials: SW
authors.lastname: Biggins
mesh_terms: D006528:Carcinoma, Hepatocellular; D006801:Humans; D008113:Liver Neoplasms; D016031:Liver Transplantation; D018579:Patient Selection