Page 893 - Read Online

Cullen et al. Hepatoma Res 2020;6:76 I http://dx.doi.org/10.20517/2394-5079.2020.69 Page 11 of 14
[63]
and the International Liver Transplantation, developed by Mazzaferro et al. . The tool is used to predict
post-transplantation HCC specific survival, considering as events of interest only those deaths caused by
tumor recurrence. The objective is to provide an upgraded prognostic tool and refine selection criteria
for liver transplantation in patients with HCC. Outcome prediction was conducted using pre-operative
determinants of prognosis frequently associated with higher risk of pre-transplantation tumor progression
and poorer post-transplantation survival. The calculator is a free accessible tool found at www.hcc-olt-
[63]
metroticket.org .
CONCLUSION
Until proven otherwise, surgical resection is the treatment of choice for patients with HCC confined to
the liver. It has been shown that even patients with advanced HCC can achieve cure with a more radical
resection as liver transplantation offers. Therefore, it is crucial that the transplant community changes the
paradigm and improves transplant criteria for patients with HCC. We should focus more on tumor biology
than size restrictions. In addition, tumor markers such as AFP and pathologic grade must be assessed.
Response to pre-transplant locoregional therapies might be a surrogate marker of more favorable disease,
which may impart lower post-transplant recurrence risk. In addition, current data proposes that PVTT
should not necessarily be considered a contraindication.

However, the question as to who should receive a liver transplant still persists. An important component
to answering this question will be the transplant surgeons who continue to push the limits and boundaries
by offering liver transplantation to advanced HCC patients. Nevertheless, the most crucial components
to what can be achieved are the patients and the donors; their willingness to accept the risks will make it
possible.

DECLARATIONS
Acknowledgments
The authors acknowledge Andres Ramos for providing assistance with the illustrations in this manuscript.

Authors’ contributions
Participated in conception and design of the study; generation, collection, assembly, interpretation and
critical revision of the data; drafting of the manuscript; approval of the final version of the manuscript:
Cullen JM
Participated in the generation, collection, assembly, interpretation and critical revision of the data; drafting
of the manuscript; approval of the final version of the manuscript: Vargas P
Participated in conception and design of the study; generation, collection, assembly, interpretation and
critical revision of the data; drafting of the manuscript; critical revision of the manuscript for important
intellectual content; approval of the final version of the manuscript: Goldaracena N

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

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

Ethical approval and consent to participate
Not applicable.