title: Liver transplantation for hepatobiliary malignancies: a new era of "Transplant Oncology" has begun.
abstract: The indications of liver transplantation for hepatobiliary malignancies have been carefully expanded in a stepwise fashion, despite the fundamental limitations in oncological, immunological, and technical aspects. A new era of "Transplant Oncology," the fusion of transplant surgery and surgical oncology, has begun, and we stand at the dawn of a paradigm shift in multidisciplinary cancer treatment. For hepatocellular carcinoma, new strategies have been undertaken to select recipients based on biological and dynamic markers instead of conventional morphological and static parameters, opening the doors for a more deliberate expansion of the Milan criteria and locoregional therapies before liver transplantation. Neoadjuvant chemoradiation therapy followed by liver transplantation for unresectable perihilar cholangiocarcinoma developed by the Mayo Clinic provided excellent outcomes in a US multicenter study; however, the surgical indications are not necessarily universal and await international validation. Similarly, an aggressive multidisciplinary approach has been applied for other tumors, including intrahepatic cholangiocarcinoma, hepatoblastoma, liver metastases from colorectal and neuroendocrine primary and gastrointestinal stromal tumors as well as rare tumors, such as hepatic undifferentiated embryonal sarcoma and infantile choriocarcinoma. In conclusion, liver transplantation is an important option for hepatobiliary malignancies; however, prospective studies are urgently needed to ensure the appropriate patient selection, organ allocation and living donation policies, and administration of antineoplastic immunosuppression.
authors.affiliation: Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan. taizohibi@z3.keio.jp.
authors.forename: Taizo
authors.initials: T
authors.lastname: Hibi
authors.affiliation: Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Itano
authors.affiliation: Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Shinoda
authors.affiliation: Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Kitagawa
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage; D001650:Bile Duct Neoplasms / Q000601:surgery*; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D018281:Cholangiocarcinoma / Q000601:surgery*; D003131:Combined Modality Therapy; D018323:Hemangioendothelioma, Epithelioid / Q000601:surgery*; D018197:Hepatoblastoma / Q000601:surgery*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery*; D016031:Liver Transplantation / Q000639:trends*; D009378:Neoplasms, Multiple Primary; D018358:Neuroendocrine Tumors / Q000601:surgery*
chemical_list: D000970:Antineoplastic Agents; D007166:Immunosuppressive Agents
keywords: Cholangiocarcinoma; Hepatocellular carcinoma; Liver metastases; Liver transplantation; Multidisciplinary cancer treatment