The Timing of Liver Transplantation Following Downstaging: Wait of Not to Wait?
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REVIEW ARTICLE
The Timing of Liver Transplantation Following Downstaging: Wait of Not to Wait? Veysel Ersan 1 & Bora Barut 1 & Sezai Yilmaz 2
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose HCC is a complex disease that is diagnosed in advanced stage and on the background of cirrhosis. Locoregional therapies provide sufficient downstaging to enable patients suitable for radical procedures such liver transplantation. However, the interval between locoregional therapies and definitive therapy is still controversial. We performed a review of literature to evaluate the role of waiting period between locoregional therapies and liver transplantation or resection from the perspective of cure and recurrence rates. Methods Thorough literature search was performed to evaluate the role of locoregional therapy and the interval to definitive therapies for the treatment of hepatocellular cancer. Results Usually, small tumors with lower tumor burden, in other words, tumors within Milan criteria, can be transplanted with an acceptable overall and disease-free survival. However, treating patients with locally advanced tumors is currently a matter of extensive research. Currently, locoregional therapies are applied to downstage the patients. However, the duration of waiting is a crucial point that needs further research. There is a consensus that the waiting interval between down-staging and transplantation should be no less than 3 months. This is important for selection of favorable tumor biology as well as from the point of antitumor immune response. Conclusion Currently, there are no surrogate markers for surveillance of response to locoregional therapies as well as the antitumor immune response that develops as a result of down-staging. Keywords Locoregional therapy . Hepatocellular carcinoma . Down-staging . Antitumor immune response . Tumor microenvironment
Abbreviations DDLT Deceased donor liver transplantation HCC Hepatocellular carcinoma IDO Indoleamine 2,3-dioxygenase LDLT Living donor liver transplantation LRT Locoregional therapies LT Liver transplantation RFA Radiofrequency ablation SBRT Stereotactic body radiation therapy TAA Tumor-associated antigens * Sezai Yilmaz [email protected] 1
Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, 244280 Malatya, Turkey
2
Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Elazig Yolu 10. Km, 44280 Malatya, Turkey
TACE TARE
Trans-arterial chemoembolization Trans-arterial radioembolization with Yttrium-90
Introduction Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer. It is usually diagnosed at advanced stages, and it is almost always together with cirrhosis [1, 2]. Liver transplantation (LT) offers the best chance of cure for both diseases [3]. In 1996, Mazzaferro et al. [4] have defined the Milan criteria and have shown that liver transplantation had excellent results in small early stage liver cancer which was compa
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