Liver transplantation for hepatocellular carcinoma: Management after the transplant. Issue 2 (9th December 2019)

• Record Type: Journal Article
• Authors: Verna, Elizabeth C.; Patel, Yuval A.; Aggarwal, Avin; Desai, Archita P.; Frenette, Catherine; Pillai, Anjana A.; Salgia, Reena; Seetharam, Anil; Sharma, Pratima; Sherman, Courtney; Tsoulfas, Georgios; Yao, Francis Y.
• Is Part Of: American journal of transplantation. Volume 20:Issue 2(2020)
• Page Start: 333
• Page End: 347
• Publication Date: 2019-12-09
• Subjects: clinical research -- hepatology -- cancer -- malignancy -- neoplasia -- liver disease: malignant -- practice -- liver transplantation; Transplantation of organs, tissues, etc -- Periodicals; 617.95
• DOI: 10.1111/ajt.15697
• Languages: English
• ISSNs: 1600-6135

Abstract

Abstract : Hepatocellular carcinoma (HCC) is an increasingly common indication for liver transplantation (LT) in the United States and in many parts of the world. In the last decade, significant work has been done to better understand how to risk stratify LT candidates for recurrence of HCC following transplant using a combination of biomarker and imaging findings. However, despite the high frequency of HCC in the LT population, guidance regarding posttransplant management is lacking. In particular, there is no current evidence to support specific post‐LT surveillance strategies, leading to significant heterogeneity in practices. In addition, there are no current recommendations regarding recurrence prevention, including immunosuppression regimen or secondary prevention with adjuvant chemotherapy. Finally, guidance on treatment of disease recurrence is also lacking and there is significant controversy about the use of immunotherapy in transplant recipients due to the risk of rejection. Thus, outcomes for patients with recurrence are poor. This paper therefore provides a comprehensive review of the current literature on post‐LT management of patients with HCC and identifies gaps in our current knowledge that are in urgent need of further investigation. Abstract : While hepatocellular carcinoma is increasingly common among liver transplant recipients, this review highlights the limited data available and the many knowledge gaps in our posttransplant monitoring and treatment of these patients.