Published online Jan 7, 2016. doi: 10.3748/wjg.v22.i1.232
Peer-review started: May 8, 2015
First decision: July 14, 2015
Revised: August 14, 2015
Accepted: November 9, 2015
Article in press: November 9, 2015
Published online: January 7, 2016
Morphological criteria have always been considered the benchmark for selecting hepatocellular carcinoma (HCC) patients for liver transplantation (LT). These criteria, which are often inappropriate to express the tumor’s biological behavior and aggressiveness, offer only a static view of the disease burden and are frequently unable to correctly stratify the tumor recurrence risk after LT. Alpha-fetoprotein (AFP) and its progression as well as AFP-mRNA, AFP-L3%, des-γ-carboxyprothrombin, inflammatory markers and other serological tests appear to be correlated with post-transplant outcomes. Several other markers for patient selection including functional imaging studies such as 18F-FDG-PET imaging, histological evaluation of tumor grade, tissue-specific biomarkers, and molecular signatures have been outlined in the literature. HCC growth rate and response to pre-transplant therapies can further contribute to the transplant evaluation process of HCC patients. While AFP, its progression, and HCC response to pre-transplant therapy have already been used as a part of an integrated prognostic model for selecting patients, the utility of other markers in the transplant setting is still under investigation. This article intends to review the data in the literature concerning predictors that could be included in an integrated LT selection model and to evaluate the importance of biological aggressiveness in the evaluation process of these patients.
Core tip: An integrated model predicting post-transplant survival of hepatocellular carcinoma patients after liver transplantation has not yet been defined. Current selection criteria for liver transplantation that do not consider its biological aggressiveness are mainly based on morphological tumor markers that offer only a static view of the tumor. Many biomarkers predicting post-transplant outcome and stratifying those patients who are candidates for liver transplantation are under evaluation. An integrated prognostic model will make it possible to quantify the tumor burden via functional imaging modalities as well as biological markers.