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2014 ; 2014
(ä): 706945
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Liver Transplantation for Hepatocellular Carcinoma beyond Milan Criteria:
Multidisciplinary Approach to Improve Outcome
#MMPMID27335840
Kornberg A
ISRN Hepatol
2014[]; 2014
(ä): 706945
PMID27335840
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The implementation of the Milan criteria (MC) in 1996 has dramatically improved
prognosis after liver transplantation (LT) in patients with hepatocellular
carcinoma (HCC). Liver transplantation has, thereby, become the standard therapy
for patients with "early-stage" HCC on liver cirrhosis. The MC were consequently
adopted by United Network of Organ Sharing (UNOS) and Eurotransplant for
prioritization of patients with HCC. Recent advancements in the knowledge about
tumor biology, radiographic imaging techniques, locoregional interventional
treatments, and immunosuppressive medications have raised a critical discussion,
if the MC might be too restrictive and unjustified keeping away many patients
from potentially curative LT. Numerous transplant groups have, therefore,
increasingly focussed on a stepwise expansion of selection criteria, mainly based
on tumor macromorphology, such as size and number of HCC nodules. Against the
background of a dramatic shortage of donor organs, however, simple expansion of
tumor macromorphology may not be appropriate to create a safe extended criteria
system. In contrast, rather the implementation of reliable prognostic parameters
of tumor biology into selection process prior to LT is mandatory. Furthermore, a
multidisciplinary approach of pre-, peri-, and posttransplant modulating of the
tumor and/or the patient has to be established for improving prognosis in this
special subset of patients.
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