Liver Transplantation for Hepatocellular Carcinoma

Dear Colleagues,

Hepatocellular carcinoma (HCC) is the fifth leading cause of cancer-related death worldwide, and its incidence is rising. The vast majority of HCC cases arise in the context of underlying chronic liver disease, most commonly related to viral hepatitis, excessive alcohol consumption, and metabolic syndrome. While the majority of HCC cases are still diagnosed at an advanced stage, surveillance programs in high-risk patients allow diagnosis at an early stage in which curative treatment can be proposed, including surgical resection, percutaneous ablation, and liver transplantation (LT). Indications depend on the tumor characteristics and degree of liver disease  (portal hypertension, bilirubin). LT is the most complete treatment, involving the removal of both the tumor(s) and the diseased liver, but it can only be offered to selected patients with early-stage HCC due to the high recurrence rates in advanced-stage HCC and the global organ shortage. Nowadays, HCC represents over 30% of indications for LT, and in appropriately selected patients, it can offer unmatched 90 and 70% 1- and 5-year survival, respectively. Selection is based on the tumor size and number (Milan criteria), with the recent addition of tumor biology markers such as the alpha-fetoprotein level (AFP score, Metroticket 2.0). Recent data suggest a role of FDG-PET scanning in patient selection. Because tumors may grow during LT workup and the organ waiting time, bridge treatment is needed to avoid progression and dropout. Besides surgery and percutaneous ablation, arterial chemoembolization has been the mainstay of such policies; however, recent advances have changed the picture. These include Y90 selective internal radiotherapy, external radiation therapy, and systemic tyrosine kinase inhibitor therapies. These newer approaches improve tumor control during waiting times but also allow downstaging of tumors otherwise outside of LT criteria. More recently, immunotherapy-based therapy has been shown to improve the survival rate in a palliative setting, but its use in the LT context remains unclear due to conflicting issues with immunosuppression and rejection. The aim of this Special Issue is to gather international experts to cover the current state of the art of LT for HCC.

Prof. Dr. Daniel Cherqui
Prof. Dr. Olivier Rosmorduc
Guest Editors

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• liver transplantation
• hepatocellular carcinoma
• transarterial chemoembolisation
• systemic therapy
• radioembolisation
• immunotherapy
• stereotactic body radiation therapy
• downstaging