title: Liver transplantation for hepatocellular carcinoma: outcomes and novel surgical approaches.
abstract: Liver transplantation for hepatocellular carcinoma (HCC) is the best treatment option for patients with early-stage tumours and accounts for ∼20-40% of all liver transplantations performed at most centres worldwide. The Milan criteria are the most common criteria to select patients with HCC for transplantation but they can be seen as too restrictive. Several proposals have been made for a moderate expansion of the criteria, which result in good outcomes but with an increase in the risk of tumour recurrence. In this Review, we provide a comprehensive overview of the outcomes after liver transplantation for HCC, focusing on tumour recurrence in terms of surveillance, prevention and treatment. Additionally, novel surgical techniques have been developed to increase the available pool of organs for liver transplantation (such as living donor liver transplantation, donation after circulatory death and split livers), but the effect of these techniques on patients with HCC is still under debate. Thus, we will describe these techniques and expose the benefits and disadvantages of each surgical approach. Finally, we will comment on the limitations of the current priority policies for liver transplantation and the need to further refine them to better serve the population.
authors.affiliation: University Health Network, Toronto General Hospital, Department of Surgery, University of Toronto, 585 University Avenue, 11-PMB-184, Toronto Ontario M5G2N2, Canada.
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Sapisochin
authors.affiliation: Barcelona Clinic Liver Cancer group, Liver Unit, Hospital Clinic, University of Barcelona, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Villaroel 170, Barcelona 08036, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Bruix
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery*; D016031:Liver Transplantation / Q000401:mortality*; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D016896:Treatment Outcome