Hepatocellular Carcinoma Management in Liver Transplantation

Hepatocellular carcinoma (HCC) is a leading indication for liver transplantation, combining curative intent with the need to balance tumour control against limited donor supply. Candidate selection relies on established criteria—most notably the Milan criteria—which correlate lesion size and number with post-transplant survival. Pre-transplant strategies, including locoregional bridge therapies such as transarterial chemoembolisation or radiofrequency ablation, aim to prevent tumour progression during waiting periods. Biomarkers such as alpha-fetoprotein and systemic inflammation indices have refined risk stratification, guiding both candidacy and urgency. Immunosuppression regimens have evolved to reduce recurrence: mammalian target of rapamycin (mTOR) inhibitors offer dual immunosuppressive and antineoplastic effects, while tailored minimisation protocols seek to preserve graft function without promoting tumour relapse. Advanced imaging and molecular profiling are yielding novel prognostic tools, including non-invasive radiomic classifiers and immune-based signatures, to predict recurrence and personalise post-transplant surveillance. Globally, standardising allocation, refining adjuvant therapies and integrating precision-medicine approaches are reshaping HCC management in transplantation, with the dual goals of extending survival and optimising organ utilisation.

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Hepatocellular Carcinoma Management in Liver Transplantation publication trend

The graph below shows the total number of articles in hepatocellular carcinoma management in liver transplantation across all publications each year (not limited to Nature Index journals).

Technical terms

Hepatocellular carcinoma (HCC): Primary malignant tumour of liver parenchymal cells, often arising in the context of chronic liver disease.

Milan criteria: Selection thresholds for liver transplantation in HCC, defined by up to three nodules ≤3 cm or a single lesion ≤5 cm, predicting low recurrence.

Tertiary lymphoid structures (TLS): Ectopic, organised lymphoid aggregates within tumours that reflect local antitumour immunity.

Radiomics: High-throughput extraction of quantitative features from medical imaging to characterise tumour phenotype.

Cytokine profiling: Quantitative analysis of circulating signaling proteins to assess systemic inflammatory and immune status.

mTOR inhibitors: Drugs targeting the mammalian target of rapamycin pathway, used for immunosuppression and possessing antiproliferative effects.

Alpha-fetoprotein (AFP): Serum oncofetal glycoprotein biomarker used to aid HCC diagnosis, prognosis and post-transplant monitoring.

References

1. The Absence of Intra‐Tumoral Tertiary Lymphoid Structures is Associated with a Worse Prognosis and mTOR Signaling Activation in Hepatocellular Carcinoma with Liver Transplantation: A Multicenter Retrospective Study. Advanced Science (2024).
2. An inflammatory liquid fingerprint predicting tumor recurrence after liver transplantation for hepatocellular carcinoma. MedComm (2024).
3. mTOR inhibitor reduces nontumour-related death in liver transplantation for hepatocellular carcinoma. Molecular Biomedicine (2024).