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Review
. 2021 Apr 28;9(2):220-226.
doi: 10.14218/JCTH.2020.00037. Epub 2021 Mar 22.

Hepatocellular Carcinoma: Downstaging to Liver Transplantation as Curative Therapy

Leana Frankul  1 , Catherine Frenette  1
Affiliations
Review

Hepatocellular Carcinoma: Downstaging to Liver Transplantation as Curative Therapy

Leana Frankul et al. J Clin Transl Hepatol. .

Abstract

Hepatocellular carcinoma (HCC) ranks among the leading cancer-related causes of morbidity and mortality worldwide. Downstaging of HCC has prevailed as a key method to curative therapy for patients who present with unresectable HCC outside of the listing criteria for liver transplantation (LT). Even though LT paves the way to lifesaving curative therapy for HCC, perpetually severe organ shortage limits its broader application. Debate over the optimal protocol and assessment of response to downstaging treatment has fueled immense research activity and is pushing the boundaries of LT candidate selection criteria. The implicit obligation of refining downstaging protocol is to ensure the maximization of the transplant survival benefit by taking into account the waitlist life expectancy. In the following review, we critically discuss strategies to best optimize downstaging HCC to LT on the basis of existing literature.

Keywords: Downstaging; Hepatocellular carcinoma; Liver transplantation; Milan criteria.

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Conflict of interest statement

Catherine Frenette reports the following conflicts of interest: Speakers Bureau for Bayer, Bristol Meyers Squibb, Eisai, Exelixis, Genentech; Advisory Board/Consultancy for Bayer, Eisai, Exelixis, Genentech; Research Support from Bayer, Merck, and Exelixis. The other author has no conflict of interests related to this publication.

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