Liver Transplantation for Hepatocellular Carcinoma

Hepatocellular carcinoma (HCC) is the most common primary liver cancer, often arising on a background of cirrhosis. Liver transplantation (LT) offers the dual advantage of removing both the tumour and the diseased liver, yielding the best long-term survival for suitably selected patients. Initially confined to the Milan criteria—a single lesion up to 5 cm or up to three tumours each ≤ 3 cm—eligibility has since expanded through integration of novel biomarkers, advanced imaging and more effective bridging therapies. Living donor liver transplantation (LDLT) has become a vital strategy to address organ shortages, enabling timely intervention and broader selection. Developments in downstaging, combining locoregional and systemic approaches, have rendered transplantation feasible for more extensive disease, including those with vascular invasion. Despite these advances, post-transplant recurrence remains a key concern, driving ongoing research into precision risk stratification, perioperative management and tailored surveillance to improve outcomes globally.

Research from Nature Portfolio

Recent efforts have centred on optimising prediction of early recurrence after LT. A foundational retrospective study introduced a composite risk score that integrates alpha-fetoprotein concentration, greatest tumour diameter, presence of vascular invasion and molecular subtyping to outperform existing criteria. This integrated model demonstrated superior discrimination for recurrence and may inform both candidate selection and intensity of post-transplant monitoring, offering a more personalised framework for clinical decision-making.

Liver Transplantation for Hepatocellular Carcinoma publication trend

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

Technical terms

Hepatocellular carcinoma (HCC): A primary liver malignancy originating in hepatocytes.

Liver transplantation (LT): Surgical replacement of a diseased liver with a healthy graft.

Milan criteria: Tumour size and number thresholds used to select candidates for transplantation.

Living donor liver transplantation (LDLT): Transplantation using a partial liver graft from a living donor.

Portal vein tumour thrombosis (PVTT): Invasion of the portal vein by cancer cells, indicating advanced disease.

Downstaging: Therapeutic interventions aimed at reducing tumour burden to meet transplant criteria.

Alpha-fetoprotein (AFP): A serum biomarker used to assess tumour activity and predict recurrence risk.

References

1. Liver Transplantation for Hepatocellular Carcinoma beyond the Milan Criteria: A Specific Role for Living Donor Liver Transplantation after Neoadjuvant Therapy. Cancers (2024).
2. Liver transplantation for advanced hepatocellular carcinoma: Controversy over portal vein tumor thrombosis. Biomedical Journal (2024).
3. Living donor liver transplantation for advanced hepatocellular carcinoma including macrovascular invasion. Journal of Cancer Research and Clinical Oncology (2021).
4. Prediction of Early Recurrence of Solitary Hepatocellular Carcinoma after Orthotopic Liver Transplantation. Scientific Reports (2019).