Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Current Hepatology Reports
Published in: Current Hepatology Reports 1/2017

01-03-2017 | Hepatic Cancer (A Singal and A Mufti, Section Editors)

Changes in Liver Transplant Criteria for Hepatocellular Carcinoma

Authors: Dekey Lhewa, Neehar D. Parikh

Published in: Current Hepatology Reports | Issue 1/2017

Login to get access

Abstract

Purpose of Review

There have been several recent policy changes in liver transplantation for hepatocellular carcinoma (HCC). We outline the most recent changes in allocation policy for HCC prior to transplant and the rationale behind them.

Recent Findings

The United Network for Organ Sharing recently adopted a new allocation policy for HCC to better balance organ availability between HCC and non-HCC waitlist candidates and exclude patients with rapidly progressive HCC. This policy includes a mandatory 6-month waiting period prior to application of model for end-stage liver disease (MELD) exception points and a cap of 34 points.

Summary

The new policies have changed the landscape of liver transplantation for HCC in the USA. The allocation policy should better select HCC patients who would have the best post-transplant outcome and balance liver transplant benefits between HCC and non-HCC patients.
Literature
1.•
Ryerson AB, Eheman CR, Altekruse SF, Ward JW, Jemal A, Sherman RL, et al. Annual report to the nation on the status of cancer, 1975-2012, featuring the increasing incidence of liver cancer. Cancer. 2016;122(9):1312–37. An important epidemiologic study which showed that liver cancer is increasing in incidence in the United States.CrossRefPubMed
2.
Rahib L, Smith BD, Aizenberg R, Rosenzweig AB, Fleshman JM, Matrisian LM. Projecting cancer incidence and deaths to 2030: the unexpected burden of thyroid, liver, and pancreas cancers in the United States. Cancer Res. 2014;74(11):2913–21.CrossRefPubMed
3.
Washburn K, Edwards E, Harper A, Freeman R. Hepatocellular carcinoma patients are advantaged in the current liver transplant allocation system. Am J Transplant. 2010;10(7):1643–8.CrossRefPubMed
4.
Goldberg D, French B, Abt P, Feng S, Cameron AM. Increasing disparity in waitlist mortality rates with increased model for end-stage liver disease scores for candidates with hepatocellular carcinoma versus candidates without hepatocellular carcinoma. Liver Transpl. 2012;18(4):434–43.CrossRefPubMed
5.
Ringe B, Pichlmayr R, Wittekind C, Tusch G. Surgical treatment of hepatocellular carcinoma: experience with liver resection and transplantation in 198 patients. World J Surg. 1991;15(2):270–85.CrossRefPubMed
6.
Bismuth H, Chiche L, Adam R, Castaing D, Diamond T, Dennison A. Liver resection versus transplantation for hepatocellular carcinoma in cirrhotic patients. Ann Surg. 1993;218(2):145–51.CrossRefPubMedPubMedCentral
7.
Bismuth H, Chiche L. Comparison of hepatic resection and transplantation in the treatment of liver cancer. Semin Surg Oncol. 1993;9(4):341–5.CrossRefPubMed
8.
Mazzaferro V, Regalia E, Doci R, Andreola S, Pulvirenti A, Bozzetti F, et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med. 1996;334(11):693–9.CrossRefPubMed
9.
Shetty K, Timmins K, Brensinger C, Furth EE, Rattan S, Sun W, et al. Liver transplantation for hepatocellular carcinoma validation of present selection criteria in predicting outcome. Liver Transpl. 2004;10(7):911–8.CrossRefPubMed
10.
Mazzaferro V, Bhoori S, Sposito C, Bongini M, Langer M, Miceli R, et al. Milan criteria in liver transplantation for hepatocellular carcinoma: an evidence-based analysis of 15 years of experience. Liver Transpl. 2011;17 Suppl 2:S44–57.CrossRefPubMed
11.
Wiesner RH, Freeman RB, Mulligan DC. Liver transplantation for hepatocellular cancer: the impact of the MELD allocation policy. Gastroenterology. 2004;127(5 Suppl 1):S261–7.CrossRefPubMed
12.
Yao FY, Bass NM, Nikolai B, Merriman R, Davern TJ, Kerlan R, et al. A follow-up analysis of the pattern and predictors of dropout from the waiting list for liver transplantation in patients with hepatocellular carcinoma: implications for the current organ allocation policy. Liver Transpl. 2003;9(7):684–92.CrossRefPubMed
13.
Hayashi PH, Trotter JF, Forman L, Kugelmas M, Steinberg T, Russ P, et al. Impact of pretransplant diagnosis of hepatocellular carcinoma on cadveric liver allocation in the era of MELD. Liver Transpl. 2004;10(1):42–8.CrossRefPubMed
14.••
Heimbach JK, Hirose R, Stock PG, Schladt DP, Xiong H, Liu J, et al. Delayed hepatocellular carcinoma model for end-stage liver disease exception score improves disparity in access to liver transplant in the United States. Hepatology. 2015;61(5):1643–50. This modeling study showed that a 6-9 month waiting period prior to granting a MELD exception for listed patients with HCC decreased the transplant disparity between HCC candidates and non-HCC candidates.CrossRefPubMedPubMedCentral
15.
Massie AB, Chow EK, Wickliffe CE, Luo X, Gentry SE, Mulligan DC, et al. Early changes in liver distribution following implementation of share 35. Am J Transplant. 2015;15(3):659–67.CrossRefPubMed
16.
Sotiropoulos GC, Molmenti EP, Losch C, Beckebaum S, Broelsch CE, Lang H. Meta-analysis of tumor recurrence after liver transplantation for hepatocellular carcinoma based on 1,198 cases. Eur J Med Res. 2007;12(10):527–34.PubMed
17.
Yao FY, Xiao L, Bass NM, Kerlan R, Ascher NL, Roberts JP. Liver transplantation for hepatocellular carcinoma: validation of the UCSF-expanded criteria based on preoperative imaging. Am J Transplant. 2007;7(11):2587–96.CrossRefPubMed
18.
Parikh ND, Waljee AK, Singal AG. Downstaging hepatocellular carcinoma: a systematic review and pooled analysis. Liver Transpl. 2015;21(9):1142–52.CrossRefPubMed
19.
Park SJ, Freise CE, Hirose R, Kerlan RK, Yao FY, Roberts JP, et al. Risk factors for liver transplant waitlist dropout in patients with hepatocellular carcinoma. Clin Transpl. 2012;26(4):E359–64.CrossRef
20.
Mehta N, Dodge JL, Goel A, Roberts JP, Hirose R, Yao FY. Identification of liver transplant candidates with hepatocellular carcinoma and a very low dropout risk: implications for the current organ allocation policy. Liver Transpl. 2013;19(12):1343–53.CrossRefPubMed
21.
Halazun KJ, Patzer RE, Rana AA, Verna EC, Griesemer AD, Parsons RF, et al. Standing the test of time: outcomes of a decade of prioritizing patients with hepatocellular carcinoma, results of the UNOS natural geographic experiment. Hepatology. 2014;60(6):1957–62.CrossRefPubMed
22.•
Mehta N, Heimbach J, Harnois DM, Dodge JL, Burns JM, Lee D, et al. Short waiting time predicts early recurrence of hepatocellular carcinoma after liver transplantation: a multicenter study supporting the “ablate and wait” principle. Boston: The Liver Meeting; 2014. This study established the criteria that predicts low risk of dropout for patients with HCC: response to locoregional therapy and low AFP level.
23.
Kim YS, Lim HK, Rhim H, Lee WJ, Joh JW, Park CK. Recurrence of hepatocellular carcinoma after liver transplantation: patterns and prognostic factors based on clinical and radiologic features. AJR Am J Roentgenol. 2007;189(2):352–8.CrossRefPubMed
24.
Roayaie S, Schwartz JD, Sung MW, Emre SH, Miller CM, Gondolesi GE, et al. Recurrence of hepatocellular carcinoma after liver transplant: patterns and prognosis. Liver Transpl. 2004;10(4):534–40.CrossRefPubMed
25.
Escartin A, Sapisochin G, Bilbao I, Vilallonga R, Bueno J, Castells L, et al. Recurrence of hepatocellular carcinoma after liver transplantation. Transplant Proc. 2007;39(7):2308–10.CrossRefPubMed
26.
Hiraoka A, Horiike N, Yamashita Y, Koizumi Y, Doi K, Yamamoto Y, et al. Efficacy of radiofrequency ablation therapy compared to surgical resection in 164 patients in Japan with single hepatocellular carcinoma smaller than 3 cm, along with report of complications. Hepatogastroenterology. 2008;55(88):2171–4.PubMed
27.•
Hameed B, Mehta N, Sapisochin G, Roberts JP, Yao FY. Alpha-fetoprotein level > 1000 ng/mL as an exclusion criterion for liver transplantation in patients with hepatocellular carcinoma meeting the Milan criteria. Liver Transpl. 2014;20(8):945–51. This study showed that a very high AFP can be highly predictive of vascular invasion and thus may be considered an exclusion criteria for liver transplantation.CrossRefPubMedPubMedCentral
28.
Vibert E, Azoulay D, Hoti E, Iacopinelli S, Samuel D, Salloum C, et al. Progression of alphafetoprotein before liver transplantation for hepatocellular carcinoma in cirrhotic patients: a critical factor. Am J Transplant. 2010;10(1):129–37.CrossRefPubMed
29.
de Mattos AA, dos Santos Schraiber L, Zanotell ML, Cantisani G. Is there an ideal cutoff for alpha-fetoprotein as an exclusion criterion for liver transplantation? Liver Transpl. 2014;20(10):1284.CrossRefPubMed
30.
Berry K, Ioannou GN. Serum alpha-fetoprotein level independently predicts posttransplant survival in patients with hepatocellular carcinoma. Liver Transpl. 2013;19(6):634–45.CrossRefPubMed
31.
Clavien PA, Lesurtel M, Bossuyt PM, Gores GJ, Langer B, Perrier A, et al. Recommendations for liver transplantation for hepatocellular carcinoma: an international consensus conference report. Lancet Oncol. 2012;13(1):e11–22.CrossRefPubMed
32.
Mazzaferro V. Squaring the circle of selection and allocation in liver transplantation for HCC: an adaptive approach. Hepatology. 2016;63(5):1707–17.CrossRefPubMedPubMedCentral
33.
Menon KV, Hakeem AR, Heaton ND. Review article: liver transplantation for hepatocellular carcinoma—a critical appraisal of the current worldwide listing criteria. Aliment Pharmacol Ther. 2014;40(8):893–902.CrossRefPubMed
34.••
Sapisochin G, Goldaracena N, Laurence JM, Dib M, Barbas A, Ghanekar A, et al. The extended Toronto criteria for liver transplantation in patients with hepatocellular carcinoma: a prospective validation study. Hepatology. 2016;64(6):2077–88. This is the first prospective study that validates the extended Toronto criteria for liver transplantation.CrossRefPubMed
35.
Yao FY, Mehta N, Flemming J, Dodge J, Hameed B, Fix O, et al. Downstaging of hepatocellular cancer before liver transplant: long-term outcome compared to tumors within Milan criteria. Hepatology. 2015;61:1968–77.CrossRefPubMedPubMedCentral
Metadata
Title
Changes in Liver Transplant Criteria for Hepatocellular Carcinoma
Authors
Dekey Lhewa
Neehar D. Parikh
Publication date
01-03-2017
Publisher
Springer US
Published in
Current Hepatology Reports / Issue 1/2017
Electronic ISSN: 2195-9595
DOI
https://doi.org/10.1007/s11901-017-0330-5

Other articles of this Issue 1/2017

Current Hepatology Reports 1/2017 Go to the issue

Hepatic Cancer (A Singal and A Mufti, Section Editors)

Advances in Pediatric Liver Tumors

Hepatic Cancer (A Singal and A Mufti, Section Editors)

Tailored Algorithms for Hepatocellular Carcinoma Surveillance: Is One-Size-Fits-All Strategy Outdated?

Hepatic Cancer (A Singal and A Mufti, Section Editors)

Liver Biopsy for Hepatocellular Carcinoma (HCC): Should this be a Routine?

Hepatic Cancer (A Singal and A Mufti, Section Editors)

Understanding LI-RADS, Its Relationship to AASLD and OPTN, and the Challenges of Its Adoption

Hepatic Cancer (A Singal and A Mufti, Section Editors)

NAFLD-Related HCC: How Should the Shift in Epidemiology Change Our Prevention and Surveillance Strategies?

Hepatic Cancer (A Singal and A Mufti, Section Editors)

Racial/Ethnic Disparities in Hepatocellular Carcinoma Epidemiology

ACC 2024 Congress Coverage

Heart Failure Video

Year in Review: Heart failure and cardiomyopathies

Watch now

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits