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 language | English |
|---|---|
| Pages (from-to) | 98-103 |
| Number of pages | 6 |
| Journal | Liver Transplantation |
| Volume | 24 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - Jan 2018 |
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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
Pro (With Caution) : Extended oncologic indications in liver transplantation. / Mazzaferro, Vincenzo; Battiston, Carlo; Sposito, Carlo.
In: Liver Transplantation, Vol. 24, No. 1, 01.2018, p. 98-103.Research output: Contribution to journal › Article
}
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.
KW - Clinical Decision-Making/methods
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
U2 - 10.1002/lt.24963
DO - 10.1002/lt.24963
M3 - Article
C2 - 29077253
VL - 24
SP - 98
EP - 103
JO - Liver Transplantation
JF - Liver Transplantation
SN - 1527-6465
IS - 1
ER -