Selection of patients with hepatocellular carcinoma for liver transplantation: Past and future

Table 1 Isolated biological criteria for the selection of candidates with hepatocellular carcinoma for liver transplantation

Ref.	Pretrasplant AFP levels (ng/mL)	Importance
Figueras et al[19]	> 300	Factor for mortality
Yao et al[16]	> 1.000	Reduced survival
Bruix[20]	> 200	Significant worse outcomes
Xu et al[21]	> 400	Higher tumor recurrence
Mailey et al[22]	Low ( ≤ 20)	Mediun and high: Higher mortality
	Mediun (20-399)
	High (≥ 400)
Muscari et al[23]		DFS	Recurrence
	Normal	71%	4%
	10-150	75%	10%
	150-500	57%	24%
	> 500	46%	62%
Chiao et al[24]	> 1.000	Reason for exclusion from the WL
Hameed et al[25]
Menon et al[26]	> 10.000	Reason for exclusion from the WL

AFP: Alpha fetoprotein; DFS: Disease-free survival; WL: Waiting list.

Table 2 Selection criteria base on radiological/morphological tumor characteristics

Ref.	Parameters	Importance
Bismuth et al[30]	Up to 3 nodules	Best results
	Each < 3 cm
Mazzaferro et al[31]	Single lesion < 5 cm	DFS > 75%
	< 3 lesions, each < 3 cm	Recurrence < 15%
	No macrovascular invasion
	No extrahepatic disease
Löhe et al[34]	Single tumor with size > 5 cm	Reduction in DFS
Yao et al[16]	Single lesion ≤ 6 cm	DFS > 75%
	2-3 lesions each ≤ 4.5 cm	Recurrence < 15%
	Total tumor diameter ≤ 8 cm
Mazzaferro[41]	Ordinates: n of tumors	Progressive reduction of 5 yr survival
	Abscissas: Tumor size
Mazzaferro et al[42]	Up to 7, as the sum of:	71.2% 5 yr survival
	Largest tumor in centimeter and n of tumors
Jang et al[46]	10 as the sum of:	If >: Decreased DFS
	Largest tumor in cm and
	n of tumors

DFS: Disease-free survival.

Table 3 Selection criteria based on functional/radiological features of the tumor

Ref.	Parameters	Importance
Hiraoka et al[56]	Hyperintensity on gadoxetic acid-enhanced MRI	HCC with more malignant potential
Ferda et al[12]	Hipervascularity or hiperaccumulation of (18)FDG/PET/with Dual-phase CT angiography (arterial/portal phase)	Distinguishing between welland
		Poorly differentiated HCC
Ochi et al[57]	High positivity in (18)FDG/PET/CT	Increase the risk of early recurrence
Kornberg et al[58]	mSUV	Reflects the existence of distant microsatellite
Kornberg[59]	Positivity in (18)FDG/PET/CT	Statistically significant lower survival post LT

CT: Computerized tomography; MRI: Magnetic resonance imaging; HCC: Hepatocellular carcinoma; PET: Positron emission tomography; LT: Liver transplantation; mSUV: Maximun standized uptake value; (18)FDG: (18)F-fluorodeoxyglucose.

Table 4 Combined morphological/biological selection criteria

Ref.	Parameters	Importance
DuBay et al[60]	Liver tumor biopsy	Excluding poorly differentiated tumors
Toso et al[52]	TTV > 115 cm3	Reduced survival at 3 yr (< 50%)
	AFP > 400 ng/mL	Limit for indication for LT
Lai et al[62]	AFP > 400 ng/mL	Strongest predictor for recurrence
	Total tumor diameter > 8 cm
Duvoux et al[63]	Model combining log10 AFP, tumor size and n of tumors: Score > or < 2	Score greater that 2 predict a market increase in 5 yr risk of recurrence and decreased survival
Berry et al[66]	AFP < 15 or > 15 ng/mL	AFP levels predicts post-transplant survival independently of MC

TTV: Total tumor volume; AFP: Alpha fetoprotein; MC: Milan criteria; LT: Liver transplantation.

Table 5 Japanese combined morphological/biological selection criteria for living-donor liver transplant

Ref.	Parameters					Importance: Limits for LDLT
	Value	1p	2p	3p	4p
Yang et al[67]	T size (cm)	≤ 3	3.1-5	5.1-6.5	> 6.5	Patients with 3-6 points are transplantable
	of tumors	1	2-3	4-5	> 5 or 6	Those with 7-12 points are not transplantable
	AFP (ng/mL)	< 20	20-200	200.1-1.000	< 1.000
Akamatsu et al[68]	Up to 5 nodules					Upper limit for LDLT
	Maximum diameter ≤ 5
Kaido et al[69]	Less that 10 nodules, all < 5 cm					Upper limit for LDLT
	DCP < 400 mAu/mL
Shirabe et al[70]	n of nodules: No limit					Upper limit for LDLT
	Maximun diameter: < 5 cm
	DCP < 300 mAu/mL

AFP: Alpha fetoprotein; DCP: Des-gamma carboxy prothrombin; LDLT: Living-donor liver transplant.