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Biolato M, Marrone G, Miele L, Gasbarrini A, Grieco A. Liver transplantation for intermediate hepatocellular carcinoma: An adaptive approach. World J Gastroenterol 2017; 23(18): 3195-3204 [PMID: 28566879 DOI: 10.3748/wjg.v23.i18.3195]
World J Gastroenterol. May 14, 2017; 23(18): 3195-3204 Published online May 14, 2017. doi: 10.3748/wjg.v23.i18.3195
Liver transplantation for intermediate hepatocellular carcinoma: An adaptive approach
Marco Biolato, Giuseppe Marrone, Luca Miele, Antonio Gasbarrini, Antonio Grieco
Marco Biolato, Giuseppe Marrone, Luca Miele, Antonio Gasbarrini, Antonio Grieco, Liver Transplant Medicine, Gastroenterological Area, Gastroenterological and Endocrino-Metabolical Sciences Department, Fondazione Policlinico Universitario Gemelli, Universita’ Cattolica del Sacro Cuore, 00168 Roma, Italy
Author contributions: Biolato M, Marrone G and Miele L performed bibliographic research and wrote the paper; Gasbarrini A and Grieco A revised the paper for important intellectual contribution.
Conflict-of-interest statement: The authors declare no conflict of interest related to this publication.
Correspondence to: Antonio Grieco, MD, Professor, Liver Transplant Medicine, Gastroenterological Area, Gastroenterological and Endocrino-Metabolical Sciences Department, Fondazione Policlinico Universitario Gemelli, Universita’ Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168 Roma, Italy. antonio.grieco@unicatt.it
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Received: January 28, 2017 Peer-review started: February 6, 2017 First decision: February 23, 2017 Revised: March 12, 2017 Accepted: April 12, 2017 Article in press: April 12, 2017 Published online: May 14, 2017 Processing time: 107 Days and 1.6 Hours
Core Tip
Core tip: Hepatocellular carcinoma is an increasing indication for liver transplantation, but the selection of patients is challenging because of organ shortages. Conventional Milan criteria is the reference for the selection of patients worldwide, but many expanded criteria have also demonstrated satisfactory results. Correct staging should include surrogate markers of biological aggressiveness. Additionally, successful down-staging can help select patients with a more favorable biology. Allocation rules are adjusted to minimize the imbalance between the priorities of candidates with and without hepatocellular carcinoma. Recently, a benefit-oriented “adaptive approach” was proposed, in which the selection and allocation of patients are based on their response to treatments.
