Pro (With Caution)

Extended oncologic indications in liver transplantation

Research output: Contribution to journalArticle

Abstract

The success of liver transplantation (LT) in curing cancer (particularly hepatocellular carcinoma and hepatic metastases from neuroendocrine tumors) is based on the augmented oncologic potentials of the total hepatectomy and on restrictive criteria applied to patient selection. Consensus on the grade of expansion of conventional limits and implementation of alternative indications to LT (cholangiocarcinoma and metastases from colorectal cancer) has not been reached. On top of regional/local conditions for wait-list dynamics and organ availability, expanded cancer indications for LT should be explored with caution. Prospective investigations should rely on staging protocols predicting the exclusive hepatic location of cancer; restrictions on clinical conditions, tumor biology, and molecular profile, including the response to neoadjuvant therapies; confirmed tumor nonresectability with curative intent; sufficient life span of the transplant candidates to assess survival and transplant benefit; and use of marginal and extended criteria donors. In conclusion, the arguments supporting moderately loosened criteria for cancer seem more valid today than in the past. Transplant oncology is likely to represent a leading field in the near future, also because comorbidities and transplant-related causes of death are better managed and often eliminated. Liver Transplantation 24 98-103 2018 AASLD.

Original languageEnglish
Pages (from-to)98-103
Number of pages6
JournalLiver Transplantation
Volume24
Issue number1
DOIs
Publication statusPublished - Jan 2018

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Liver Transplantation
Transplants
Liver Neoplasms
Neoplasms
Neoplasm Metastasis
Neoadjuvant Therapy
Neuroendocrine Tumors
Cholangiocarcinoma
Hepatectomy
Patient Selection
Comorbidity
Molecular Biology
Cause of Death
Hepatocellular Carcinoma
Colorectal Neoplasms
Liver

Keywords

  • Clinical Decision-Making/methods
  • Consensus
  • End Stage Liver Disease/etiology
  • Humans
  • Liver Neoplasms/complications
  • Liver Transplantation/methods
  • Medical Oncology/methods
  • Neoplasm Staging
  • Patient Selection
  • Risk Assessment/methods
  • Severity of Illness Index
  • Waiting Lists

Cite this

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title = "Pro (With Caution): Extended oncologic indications in liver transplantation",
abstract = "The success of liver transplantation (LT) in curing cancer (particularly hepatocellular carcinoma and hepatic metastases from neuroendocrine tumors) is based on the augmented oncologic potentials of the total hepatectomy and on restrictive criteria applied to patient selection. Consensus on the grade of expansion of conventional limits and implementation of alternative indications to LT (cholangiocarcinoma and metastases from colorectal cancer) has not been reached. On top of regional/local conditions for wait-list dynamics and organ availability, expanded cancer indications for LT should be explored with caution. Prospective investigations should rely on staging protocols predicting the exclusive hepatic location of cancer; restrictions on clinical conditions, tumor biology, and molecular profile, including the response to neoadjuvant therapies; confirmed tumor nonresectability with curative intent; sufficient life span of the transplant candidates to assess survival and transplant benefit; and use of marginal and extended criteria donors. In conclusion, the arguments supporting moderately loosened criteria for cancer seem more valid today than in the past. Transplant oncology is likely to represent a leading field in the near future, also because comorbidities and transplant-related causes of death are better managed and often eliminated. Liver Transplantation 24 98-103 2018 AASLD.",
keywords = "Clinical Decision-Making/methods, Consensus, End Stage Liver Disease/etiology, Humans, Liver Neoplasms/complications, Liver Transplantation/methods, Medical Oncology/methods, Neoplasm Staging, Patient Selection, Risk Assessment/methods, Severity of Illness Index, Waiting Lists",
author = "Vincenzo Mazzaferro and Carlo Battiston and Carlo Sposito",
note = "{\circledC} 2017 by the American Association for the Study of Liver Diseases.",
year = "2018",
month = "1",
doi = "10.1002/lt.24963",
language = "English",
volume = "24",
pages = "98--103",
journal = "Liver Transplantation",
issn = "1527-6465",
publisher = "John Wiley and Sons Ltd",
number = "1",

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TY - JOUR

T1 - Pro (With Caution)

T2 - Extended oncologic indications in liver transplantation

AU - Mazzaferro, Vincenzo

AU - Battiston, Carlo

AU - Sposito, Carlo

N1 - © 2017 by the American Association for the Study of Liver Diseases.

PY - 2018/1

Y1 - 2018/1

N2 - The success of liver transplantation (LT) in curing cancer (particularly hepatocellular carcinoma and hepatic metastases from neuroendocrine tumors) is based on the augmented oncologic potentials of the total hepatectomy and on restrictive criteria applied to patient selection. Consensus on the grade of expansion of conventional limits and implementation of alternative indications to LT (cholangiocarcinoma and metastases from colorectal cancer) has not been reached. On top of regional/local conditions for wait-list dynamics and organ availability, expanded cancer indications for LT should be explored with caution. Prospective investigations should rely on staging protocols predicting the exclusive hepatic location of cancer; restrictions on clinical conditions, tumor biology, and molecular profile, including the response to neoadjuvant therapies; confirmed tumor nonresectability with curative intent; sufficient life span of the transplant candidates to assess survival and transplant benefit; and use of marginal and extended criteria donors. In conclusion, the arguments supporting moderately loosened criteria for cancer seem more valid today than in the past. Transplant oncology is likely to represent a leading field in the near future, also because comorbidities and transplant-related causes of death are better managed and often eliminated. Liver Transplantation 24 98-103 2018 AASLD.

AB - The success of liver transplantation (LT) in curing cancer (particularly hepatocellular carcinoma and hepatic metastases from neuroendocrine tumors) is based on the augmented oncologic potentials of the total hepatectomy and on restrictive criteria applied to patient selection. Consensus on the grade of expansion of conventional limits and implementation of alternative indications to LT (cholangiocarcinoma and metastases from colorectal cancer) has not been reached. On top of regional/local conditions for wait-list dynamics and organ availability, expanded cancer indications for LT should be explored with caution. Prospective investigations should rely on staging protocols predicting the exclusive hepatic location of cancer; restrictions on clinical conditions, tumor biology, and molecular profile, including the response to neoadjuvant therapies; confirmed tumor nonresectability with curative intent; sufficient life span of the transplant candidates to assess survival and transplant benefit; and use of marginal and extended criteria donors. In conclusion, the arguments supporting moderately loosened criteria for cancer seem more valid today than in the past. Transplant oncology is likely to represent a leading field in the near future, also because comorbidities and transplant-related causes of death are better managed and often eliminated. Liver Transplantation 24 98-103 2018 AASLD.

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KW - Consensus

KW - End Stage Liver Disease/etiology

KW - Humans

KW - Liver Neoplasms/complications

KW - Liver Transplantation/methods

KW - Medical Oncology/methods

KW - Neoplasm Staging

KW - Patient Selection

KW - Risk Assessment/methods

KW - Severity of Illness Index

KW - Waiting Lists

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