Abstract
The incidence of hepatocellular carcinoma (HCC) has been on the rise in the United States in the past few decades. Liver transplantation is considered the treatment of choice for patients who present with stage II HCC and fall within the MILAN criteria with a 5-year overall survival of 65–70 %. Unfortunately, most of the patients present with advanced disease and only 10–20 % are eligible for orthotopic liver transplant (OLT). In an attempt to help patients meet the criteria for OLT, several modalities are being used to decrease tumor load and downstage patients, namely, radiofrequency ablation (RFA) and transarterial chemoembolization (TACE). The main problems with the concept of downstaging reside in identifying patients who should undergo downstaging, defining the end points of successful downstaging and deciding on a reasonable time frame before listing for transplant. Several reports have been published that show good results with downstaging. The percentage of patients who were successfully downstaged in published series ranged from 24 % to 70 %. Overall survival after downstaging and OLT was approximately 65 % at 5 years in most of the series. This supports the idea that downstaging is a reasonable method for treatment of patients who present with unresectable HCC that do not fit the criteria for initial liver transplantation. It is also useful in selecting patients with favorable biology that would otherwise not receive OLT. There is currently no evidence in the literature to suggest that patients who are downstaged and receive OLT do worse than patients that present within MILAN transplant criteria, a notion that should drive surgeons and hepatologists to aggressively treat stage III HCC patients with the goal of downstaging.
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Khreiss, M., Geller, D.A. (2015). Downstaging Hepatocellular Carcinoma for Liver Transplantation. In: Doria, C. (eds) Contemporary Liver Transplantation. Springer, Cham. https://doi.org/10.1007/978-3-319-05543-5_13-1
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DOI: https://doi.org/10.1007/978-3-319-05543-5_13-1
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Downstaging Hepatocellular Carcinoma for Liver Transplantation- Published:
- 22 September 2016
DOI: https://doi.org/10.1007/978-3-319-05543-5_13-2
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Downstaging Hepatocellular Carcinoma for Liver Transplantation- Published:
- 18 February 2015
DOI: https://doi.org/10.1007/978-3-319-05543-5_13-1