J Liver Cancer.  2021 Sep;21(2):105-112. 10.17998/jlc.2021.03.17.

Liver transplantation for hepatocellular carcinoma with portal vein tumor thrombosis

• Kim SJ
• Kim JM

• KMID: 2520897
• DOI: http://doi.org/10.17998/jlc.2021.03.17

Abstract

Traditionally, liver transplantation for hepatocellular carcinoma with portal vein tumor thrombosis is not recommended. However, with recent developments in locoregional therapies for hepatocellular carcinoma, more aggressive treatments have been attempted for advanced hepatocellular carcinoma. Recently, various studies on locoregional therapies for downstaging followed by living donor liver transplantation reported inspiring overall survival and recurrence-free survival of patients. These downstaging procedures included three-dimensional conformal radiation therapy, trans-arterial chemoembolization, stereotactic body radiation therapy, trans-arterial radioembolization, hepatic arterial infusion chemotherapy and combinations of these therapies. Selection of the optimal downstaging protocol should depend on tumor location, biology and background liver status. The risk factors affecting outcome include pre-downstaging alpha-fetoprotein values, delta alpha-fetoprotein values, disappearance of portal vein tumor thrombosis on imaging and meeting the Milan criteria or not after downstaging. For hepatocellular carcinoma with portal vein tumor thrombosis, downstaging procedure with liver transplantation in mind would be helpful. If the reaction of the downstaged tumor is good, liver transplantation may be performed.

Keyword

Hepatocellular carcinoma; Portal vein; Thrombosis; Liver transplantation

Figure

• 

  Figure 1 Portal vein tumor thrombosis classification according to location. (A) Vp1, tumor thrombus distal to the second-order branch of the portal vein but not in the second-order branch. (B) Vp2, tumor invasion of the second-order branch. (C) Vp3, tumor invasion of the first-order branch. (D) Vp4, tumor invasion of the main portal vein and/or the portal vein branch contralateral to the primarily involved lobe.

Reference

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