![]() ![]() Our main perspective is to convey our idea, which is that selection criteria that are and will be developed will never be ideal so they will be universally accepted. Furthermore, we aimed to give a historical perspective regarding development of LT as a valid alternative for treatment of patients with HCC. The aim of the present review is to give a broad perspective regarding management of HCC prioritizing LT as the main treatment modality. Therefore, management of the patients with HCC up to the final point of LT forms the basis of all the auxiliary treatment methods including transarterial therapies, local ablative procedures and liver resections. This resulted in development of diverse patient selection criteria and management protocols for approaching patients with HCC. ![]() However, the path from LT to definition of the current criteria has not been easy, and a lot of obstacles have been encountered and solutions have been developed. In 2020, the International Liver Transplantation Society Transplant Oncology consensus report stated that the minimum overall 5-year survival rate should be 60% for an acceptable result in LDLT for HCC. Volk et al stated that for HCC exceeding Milan criteria but within the University of California San Francisco (UCSF) criteria, the minimum overall 5-year survival rate requirement should be 61% so that it will not have a negative impact on other patients on the waiting list for non-malignant diseases. In general, LT for any disease is considered acceptable if the 5-year survival rate is ≥ 50%. Therefore, using a valuable resource for patients with malignancy should be performed in accord with very strict criteria to choose the patient that will benefit the most from transplantation. However, the demand for organs is overwhelmingly higher than the deceased donor organ supply. So far, this patient group has contributed to the accumulation of the data regarding the existing extended criteria that are available. Since these patients do not have an impact on the waiting list, they can be rapidly transplanted. On the other hand, in patients beyond the Milan criteria, the extended criteria can be chosen to optimally select the patient that will benefit most from the LT without risking the living donor. In patients with tumors within the Milan criteria, bridging procedures can be eliminated because patients do not have to wait on the deceased donor organ waiting list. LT from a living liver donor has a significant impact on patients with HCC. Furthermore, living donor LT (LDLT) has revolutionized the treatment of HCC. ![]() For LT, optimal patient selection criteria is the key to a successful outcome. LT treats the underlying cirrhosis, and it is the gold standard treatment of the cancer. The success of treatment depends on the selection of patients that will benefit from the aggressive multimodality therapy. Treatment options that will achieve this goal include many options, from minimally invasive interventional methods such as local regional treatments to highly complex treatment methods such as liver transplantation (LT). The main goal of treatment of patients with HCC is to provide prolonged and disease-free survival (DFS). ![]() On the other hand, HCC is the third most common cause of cancer-related deaths causing 830180 deaths annually. The goal will be achieved by a harmonic interplay between basic science researchers and clinicians.Ĭurrently, hepatocellular carcinoma (HCC) is the sixth most common cancer with 905677 new cases diagnosed annually. The same is true for treatment modalities. Ideal selection criteria are yet to be discovered. Treatment of hepatocellular carcinoma needs a multidisciplinary approach. On the other hand, it was seen that the recurrence rates had increased as the Milan criteria were exceeded the 5-year recurrence rates ranged between 4.9% to 39.9%. All criteria have 5-year overall survival rates that were comparable to the Milan Criteria and ranged between 60%-85%. In the present review article, we have summarized all the criteria and scoring systems regarding LT for hepatocellular carcinoma. Current criteria for patient selection do not only consider morphologic characteristics such as tumor size and number of tumor nodules but also biologic markers that show tumor aggressiveness is also being considered. However, in living donor LT, the Milan criteria is being extended. Milan criteria have been defined 25 years ago and still is being used for patient selection for LT. Liver transplantation (LT) for hepatocellular carcinoma is still a hot topic, and the main factor that is associated with the success of treatment is to determine the patients who will benefit from LT. ![]()
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