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Kornberg et al. Hepatoma Res 2018;4:60 Hepatoma Research
DOI: 10.20517/2394-5079.2018.86

Review Open Access

Liver transplantation for hepatocellular carcinoma -
non-cancer factors and implications for improving
outcome beyond standard tumor criteria

Arno Kornberg, Martina Schernhammer

Department of Surgery, Klinikum rechts der Isar, Technical University Munich, Munich D-81675, Germany.
Correspondence to: Dr. Arno Kornberg, Department of Surgery, Klinikum rechts der Isar, Technical University Munich, Munich D-81675,
Germany. E-mails: ArnoKornberg@aol.com

How to cite this article: Kornberg A, Schernhammer M. Liver transplantation for hepatocellular carcinoma - non-cancer factors and
implications for improving outcome beyond standard tumor criteria. Hepatoma Res 2018;4:60.
http://dx.doi.org/10.20517/2394-5079.2018.86
Received: 6 Jul 2018 First Decision: 16 Aug 2018 Revised: 27 Aug 2018 Accepted: 28 Aug 2018 Published: 29 Sep 2018

Science Editor: Guang-Wen Cao Copy Editor: Yuan-Li Wang Production Editor: Zhong-Yu Guo

Abstract
Liver transplantation (LT) is recognized as best treatment option in patients with early hepatocellular cancer
(HCC) in underlying liver cirrhosis. Apart from tumor size and number implemented in the Milan criteria, which
are current worldwide standards for patient selection, several biological tumor factors have been identified to
affect cancer-specific outcome. In particular, grading and vascular tumor invasions were shown to correlate with
aggressive biological tumor behavior and poor survival following LT. Identifying tumors with favorable biology
is one important approach for expanding the pool of eligible liver recipients beyond the Milan burden limits.
Improving the immunological state and condition for appropriate defense against circulating cancer cell attack
may be another important prognostic aspect. Therefore, there is increasing interest in non-cancer factors related
to the peritransplant period that may influence the oncological outcome by providing negative immunomodulatory
actions. Considering and modulation of these non-HCC factors of prognosis might contribute in safely expanding
the HCC LT selection criteria.

Keywords: Hepatocellular carcinoma, liver transplantation, tumor biology, non-cancer factors, outcome

INTRODUCTION
In the last 40 years, liver transplantation (LT) has developed as a generally accepted standard procedure in the
treatment of a wide range of end-stage liver diseases. Especially liver replacement for hepatocellular carcinoma
[1]
(HCC) in underlying liver cirrhosis became a phenomenal story of clinical success in oncological surgery .

© The Author(s) 2018. Open Access This article is licensed under a Creative Commons Attribution 4.0
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