AI Article Synopsis
- Liver transplantation (LT) is the best treatment for hepatocellular carcinoma (HCC), but donor shortages have led to strict eligibility criteria, prompting efforts to expand these criteria as donor availability increases and new therapies emerge.
- The introduction of immune checkpoint inhibitors (ICIs) has transformed HCC treatment but creates challenges for LT, particularly regarding immunosuppression management before and after the procedure.
- The review aims to assess new evidence and its impact on LT for HCC, focusing on balancing individual patient needs with benefits for the broader population in the transplantation system.
Article Abstract
Background And Aims: Despite liver transplantation (LT) is considered the optimal treatment for hepatocellular carcinoma (HCC), particularly in patients with impaired liver function, the shortage of donors has forced the application of very restrictive criteria for selecting ideal candidates for whom LT can offer the best outcome. With the evolving LT landscape due to the advent of direct-acting antivirals (DAAs) and the steady increase in donors, major efforts have been made to expand the transplant eligibility criteria for HCC. In addition, the emergence of immune checkpoint inhibitors (ICIs) for the treatment of HCC, with demonstrated efficacy in earlier stages, has revolutionized the therapeutic approach for these patients, and their integration in the setting of LT is challenging. Management of immunological compromise from ICIs, including the wash-out period before LT and post-LT immunosuppression adjustments, is crucial to balance the risk of graft rejection against HCC recurrence. Additionally, the effects of increased immunosuppression on non-hepatic complications must be understood to prevent them from becoming obstacles to long-term OS.
Methods And Results: In this review, we will evaluate the emerging evidence and its implications for the future of LT in HCC. Addressing these novel challenges and opportunities, while integrating the current clinical evidence with predictive algorithms, would ensure a fair balance between individual patient needs and the overall population benefit in the LT system.
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| http://dx.doi.org/10.1111/liv.16142 | DOI Listing |
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