Liver Transplantation for Hepatocellular Carcinoma: A Survey of Practices

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Abstract

Goal

To survey physician practices regarding liver transplantation for patients with hepatocellular carcinoma (HCC).

Background

Many issues surrounding liver transplantation for HCC are controversial and physician practices have not been well characterized.

Methods

Transplant physicians and surgeons were electronically surveyed regarding surveillance, diagnosis, selection criteria for deceased and living donor transplantation, and use of adjunctive therapy for HCC.

Results

Eighty-nine of 174 (51%) physicians completed the survey (39 hepatologists, 41 transplant surgeons, and 9 others). Most respondents were from large US transplant centers. All reported screening for HCC during transplant evaluation, and 98% surveyed patients awaiting transplant. Sixty percent of respondents would biopsy lesions under selective conditions, whereas 32% never biopsy lesions, and 8% biopsy all lesions. Eighty two percent of respondents claimed to adhere to the Milan criteria (single lesion ≤5 cm or no more than 3 lesions each ≤3 cm without vascular invasion) for patient selection, however, 36% would transplant patients with tumors that invade a small portal branch. Forty one percent of respondents would consider living donor transplantation for patients with tumors exceeding the Milan criteria. Ninety-six percent of respondents treat HCC before transplantation, and 87% would transplant patients down-staged to meet the Milan criteria.

Conclusions

There is consistency related to HCC surveillance and treatment in liver transplant candidates. Variations of responses regarding biopsy of lesions, patient selection for deceased donor and living donor transplantation highlight a need for evidence-based guidelines.

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