Clinical Development and Challenges in Liver Transplantation for Hepatocellular Carcinoma

Dear Colleagues,

Liver transplantation remains the cornerstone treatment for early-stage hepatocellular carcinoma (HCC), considering the generally excellent recurrence-free survival rates; however, the scarcity of sufficient organs as well as the eligibility criteria for patients to qualify for liver transplantation have been challenges to overcome.

Over the years, the (epi)genetics and biology of HCC and its subtypes have been better characterized. Besides α-fetoprotein (AFP), PIVKA-II has been identified as a biomarker of HCC in an attempt to determine prognoses, guide treatment, monitor follow-ups, and predict biological behavior.

In the evolution of patient qualification for liver transplantation, the widely adopted Milan criteria have, ever since their implementation, been subject to expansion. Hence, more progressive criteria, expanding mainly in terms of tumor size and number, have been developed and implemented in order to offer more patients the option to receive a liver transplantation.

Ideally, criteria for transplantation are based on variables that predict biological behavior in order to select those patients who would benefit the most. In extending the indication for liver transplantation for HCC, one of the challenges is the increased demand of donors/grafts that already fall short of current indications in the vast majority of countries. Thus, extending the donor pool by living donor programs, alongside the rise in liver perfusion techniques in order to test extended donor grafts, has been implemented.

In this Special Issue of Cancers, the clinical development and challenges of liver transplantation for HCC will be addressed by highlighting current developments and challenges with respect to transplant criteria, oncological outcomes, bridging/downstaging, neoadjuvant therapy, and donor pool expansion.

Dr. Roeland F. de Wilde
Dr. Wojciech G. Polak
Prof. Dr. Jan N.M. IJzermans
Guest Editors

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• hepatocellular carcinoma
• HCC
• liver transplantation
• transplant oncology
• staging
• prognosis
• downstaging
• bridging
• overall survival