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Fatourou et al. Hepatoma Res 2018;4:63 I http://dx.doi.org/10.20517/2394-5079.2018.62 Page 9 of 11

CONCLUSION
Successful eradication of hepatitis C virus, following the widespread use and efficacy of the direct acting
antiviral (DAA) treatment, has already reduced the number of patients with HCV related cirrhosis requiring
LT. As a result, HCC and non-alcoholic fatty liver disease are becoming the leading causes for LT in the
USA and in Europe. Transplantation for HCC is challenging, as one has to ensure that disease-free survival
remains similar to that of patients transplanted due to benign disease. Similarly, it is equally important to
ensure that HCC patients are not disadvantaged and erroneously excluded from liver transplantation, based
on tumour volume characteristics alone. It is likely therefore that with the reduction of the HCV burden,
transplant programs will become less restrictive. Moreover, with alternative biomarkers and the use of liquid
biopsies as prognostic tools in HCC, a more “biological” rather than “morphological” approach to HCC
treatment is anticipated.

Until these more refined methods for selecting patients become available, existing evidence supports the use
of AFP in decision models for LT. Whether an AFP slope can be more informative compared to a static single
value remains unclear. Of the currently available models the “AFP model” is currently the most extensively
utilised and validated. The Metroticket 2.0 calculator allows an individualised accurate prediction of post LT
recurrence and can be used by different transplant programs, which can be more permissive or restrictive
based on the recurrence rates they are willing to accept. Finally, models that incorporate AFP at different
cut-offs have shown be superior to Milan criteria in predicting recurrence, but require to be prospectively
validated in order to confirm their prognostic value.

DECLARATIONS
Authors’ contributions
Drafted the manuscript: Fatourou EM
Reviewed the manuscript and made the appropriate corrections: Suddle AR, Heneghan MA

Availability of data and materials
Not applicable.

Financial support and sponsorship
Heneghan MA is funded by research support from the King’s College Hospital Charity (Orpin Bequest and
Kelly Group), and the European Association for the Study of Liver.

Conflicts of interest
Both authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Not applicable.

Copyright
© The Author(s) 2018.

REFERENCES
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the most common indication for liver transplantation and placement on the waitlist in the United States. Clin Gastroenterol Hepatol
2017;15:767-75.