Risk assessment criteria in liver transplantation for hepatocellular carcinoma: proposal to improve transplant oncology

Abstract

Liver transplantation for hepatocellular carcinoma has proved to be a highly effective cure if the right patient can be selected. Milan criteria has traditionally guided physicians toward appropriate liver allocation but changes in clinical practice, patient populations and recent developments in biomarkers are decreasing Milan criteria's utility. At the same time, the literature has flooded with a diversity of new criteria that demonstrate strong predictive power and are better suited for current clinical practice. In this article, the utility of newly proposed criteria will be reviewed and important issues to improve future criteria will be addressed in hopes of opening a discussion on how key questions surrounding criteria for liver transplantation of hepatocellular carcinoma can be answered.

Figure 1.. Summary of proposed criteria: characteristics of proposed criteria including type of output and metrics used.

deMELD: Dropout equivalent model for end-stage liver disease; HALTHCC: Hazard associated with liver transplantation for hepatocellular carcinoma; LRT: Locoregional therapy; MELD: Model for end-stage liver disease; MELD_EQ: Equivalent model for end-stage liver disease; Moral: Model of recurrence after liver transplantation; Retreat: Risk estimation of tumor recurrence after transplant; TRAIN: Time, radiological response, alpha-fetoprotein and inflammation score; TTV-AFP: Total tumor volume and alpha-fetoprotein; UCSF: University of California San Francisco.