J Korean Soc Transplant.  2010 Mar;24(1):4-12. 10.4285/jkstn.2010.24.1.4.

Liver Transplantation for Advanced Hepatocellular Carcinoma

• Lee KW
• Suh KS

• KMID: 2202217
• DOI: http://doi.org/10.4285/jkstn.2010.24.1.4

Abstract

Hepatocellular carcinoma (HCC) has become an important indication for liver transplantation in Korea. Even though the Milan criteria have been accepted as the gold standard in deceased donor liver transplantation, the acceptable indication for living donor liver transplantation is controversial. This review covers several key issues in liver transplantation for advanced HCC: (1) recent developments and published data on expanded criteria, (2) the role of down-staging, (3) an ethical issue in expanding the criteria in living donor liver transplantation, and (4) post-operative management, including the immunosuppressive regimen and post-transplant adjuvant chemotherapy to improve survival after transplantation for advanced HCC. Biological factors, such as AFP, PIVKA-II, and a PET scan, in addition to tumor size and number, may be helpful in selecting eligible patients for liver transplantation among patients with advanced HCC. Low-level immunosuppression with low exposure of calcineurin inhibitor may reduce HCC recurrence after transplantation.

Keyword

Advanced hepatocellular carcinoma; Expanded criteria; Immunosuppressive regimen; Liver transplantation

MeSH Terms

Biological Factors
Biomarkers
Calcineurin
Carcinoma, Hepatocellular
Chemotherapy, Adjuvant
Humans
Immunosuppression
Korea
Liver
Liver Transplantation
Living Donors
Positron-Emission Tomography
Protein Precursors
Prothrombin
Recurrence
Tissue Donors
Transplants
Biological Factors
Calcineurin
Protein Precursors
Prothrombin

Figure

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  Fig. 1. The HCC ‘Metro Ticket' – the further the distance, the higher the price. Abbreviations: HCC, hepatocellular carcinoma; UCSF, University of California San Francisco. Reprinted from Fig. 1 of reference [5].

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  Fig. 2. Proposed extended criteria in Asia to show comparable outcome to the Milan criteria. Abbreviations: AMC, Asan Medical Center; SMC, Samsung Medical Center; SNU, Seoul National University; UCSF, University of California San Francisco.

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  Fig. 3. Kaplan-Meier survival analysis according to 18F-FDG PET findings. Patients with TSUVmax/LSUVmax less than 1.15 showed significantly better survival than those with TSUVmax/LSUVmax of 1.15 or more (P＜0.001). Abbreviations: 18F-FDG PET, 18 fluorodeoxyglucose positron emission tomography; LSUVmax, normal liver standard uptake value max; TSUVmax, tumor standard uptake value max. Reprinted from Fig. 4 of reference [20].

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  Fig. 4. Reported activities of calcineurin inhibitors related to cancer and transplantation. Predicted effect in the presence of calcineurin inhibitors (circled arrows). Abbreviations: EBV, Epstein-Barr virus; IL-6, interleukin 6; MDR, multidrug resistance; TGF-ß, transforming growth factor; VEGF, vascular endothelial growth factor. Reprinted from Fig. 1 of reference [34].

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  Fig. 5. Reported activities of rapamycin related to cancer and transplantation. Predicted effect in the presence of rapamycin (circled arrows). Abbreviations: IL-6, interleukin 6; mTOR, mammalian target of rapamycin; PTEN, phosphatase and tension homologue deleted on chromosome 10; VEGF, vascular endothelial growth factor. Reprinted from Fig. 2 of reference [34].

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