Liver transplantation for hepatocellular carcinoma

Česká verzia

Authors: Pavel Taimr
Authors place of work: Klinika hepatogastroenterologie, Institut klinické a experimentální medicíny, Praha
Published in the journal: Gastroent Hepatol 2024; 78(2): 123-128
Category: Hepatology
doi: https://doi.org/10.48095/ccgh2024123

Summary

The number of liver transplants for the indication of hepatocellular carcinoma is increasing. We consider the so-called Milan criteria, based on the number and size of the tumour, to be the basic indication framework. However, the original criteria are too restrictive – they prevent access to transplantation for a number of patients who would otherwise be suitable candidates for transplantation. There is therefore an effort to somehow expand these criteria. Decision-making is also burdened by a possible error in imaging – our knowledge of the dimensions and number of nodules is not accurate before transplantation. Later, factors reflecting the biological properties of the tumour were added and it was possible to select patients for transplantation with greater precision. Examples here include the use of alpha-fetoprotein, histological grading, microinvasion into vessels, etc. Also, the response of the tumour to treatment before transplantation can be an important indicator – the effect of locoregional (RFA, MWA, TACE) or even systemic treatment. The importance of pre-transplant administration of immunomodulatory treatment is not yet known. In larger transplant centres, the concept of their own criteria, established on the basis of their own data unique to a given centre, is already beginning to be promoted. The advantage is that it reflects local and specific conditions of the centre.

Keywords:

liver transplantation – hepatocellular carcinoma – Milan criteria – IKEM criteria

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ORCID autora

P. Taimr 0000-0002-6272-4608b.

Doručeno/Submitted: 30. 3. 2024

Přijato/Accepted: 9. 4. 2024

doc. MUDr. Pavel Taimr, Ph.D.

vedoucí transplantační hepatolog

Klinika hepatogastroenterologie

Institut klinické a experimentální medicíny

Vídeňská 1958/9

140 21 Praha 4

pavel.taimr@ikem.cz