2/28/2024 0 Comments Meld criteria2 Initially, poor patient selection (advanced tumor burden, unclear tumor etiology) resulted in high rates of tumor recurrence post-transplant. Liver transplant is an excellent therapeutic option for long-term survival in patients with HCC, as it eliminates both HCC and the underlying advanced liver disease. Surgical resection, orthotopic liver transplant (OLT), and ablative techniques are potentially the only curative options available for HCC. 4 Currently, it is estimated that the median survival for untreated HCC is less than 1 year. 3 Recent data has shown that only 46% of HCC cases are diagnosed early on and most are unable to receive curative therapy. 1, 2 The incidence of HCC has been rising in the USA over the last 20 years and has been attributed to risk factors, such as chronic hepatitis C infection, hepatitis B infection, heavy alcohol use, diabetes, and nonalcoholic fatty liver disease, among others. Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related death worldwide, being the fifth most common malignancy and the third most common cause of cancer-related mortality. Monitoring response to locoregional therapy and longer wait times after locoregional therapy prior to transplant can serve as surrogate markers of tumor biology as well. HCC presenting beyond Milan criteria can also be down-staged with locoregional therapy. Tumor markers, such as alpha-fetoprotein, can also be used to follow treatment of HCC and possibly exclude patients from transplant. This has led to a number of expanded criteria for liver transplantation, concerning both overall size and number of lesions, as well as incorporation of other markers of tumor biology. However, many believe that the Milan criteria may be too strict in regard to its size requirements for lesions. ![]() ![]() The Milan criteria (1 lesion greater than or equal to 2 cm and less than or equal to 5 cm, or up to 3 lesions, each greater than or equal to 1 cm and less than or equal to 3 cm) have been adopted by many transplant societies worldwide as the criteria to determine whether patients with HCC can move forward with liver transplantation. Liver transplantation is an optimal treatment option, as it eliminates HCC as well as the underlying liver disease. The incidence of HCC has been rising in the USA over the last 20 years. ![]() Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related death worldwide, being the fifth most common cancer and the third most common cause of cancer-related mortality.
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