Posttransplant management of recipients undergoing liver transplantation for hepatocellular carcinoma. Working Group Report from the ILTS Transplant Oncology Consensus Conference
Berenguer M (1), Burra P (2), Ghobrial M (3), Hibi T (4), Metselar H (5), Sapisochin G (6), Bhoori S (7), Man NK (8), Mas V (9), Ohira M (10), Sangro B (11), van der Laan LJW (12).
(1) Hepatology - Liver Transplantation Unit, Digestive Medicine Service, IIS La Fe and CIBER-EHD, Hospital Universitari i Politècnic La Fe, Valencia, Spain and Department of Medicine, Universitat de València, Valencia, Spain.
(2) Multivisceral Transplant Unit, Gastroenterology. Department of Surgery, Oncology and Gastroenterology. Padua University Hospital. Padua Italy.
(3) J C Walter Jr Transplant Center, Sherrie and Alan Conover Center for Liver Disease and Transplantation, Weill Cornell Medical College, Houston Methodist Hospital and Research Institute, Houston, TX, USA.
(4) Kumamoto University Graduate School of Medical Sciences (Kumamoto, Japan).
(5) Department of Gastroenterology and Hepatology, Erasmus MC - University Medical Center Rotterdam, the Netherlands.
(6) Multi-Organ Transplant Program, Division of General Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada.
(7) Gastro-Hepato-Pancreatic Surgery and Liver Transplant Unit, Istituto Nazionale Tumori, Milan Italy.
(8) Department of Surgery, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
(9) Transplant Research Institute, James D. Eason Transplant Institute, Department of Surgery. The University of Tennessee Health Science Center.
(10) Medical Center for Translational and Clinical Research, Hiroshima University Hospital, Hiroshima, JAPAN.
(11) Clínica Universidad de Navarra-IDISNA and CIBEREHD, Pamplona, Spain.
(12) Department of Surgery, Erasmus MC - University Medical Center Rotterdam, The Netherlands.
Although liver transplantation (LT) is the best treatment for patients with localized hepatocellular carcinoma (HCC), recurrence occurs in 6%-18% of patients.
Several factors, particularly morphological criteria combined with dynamic parameters, known prior to LT modify this risk and combined in prediction models may be used to stratify patients at need of variable surveillance strategies.
Additional variables though likely explain differences in recurrence rates in patients with the same pre-LT HCC status. One of these variables is possibly immunosuppression (IS). Once recurrence takes place, management is highly heterogenous. Within the ILTS Consensus Conference on Liver Transplant Oncology, working group 4 aim was to analyse the data regarding posttransplant management of recipients undergoing LT for HCC.
Three areas of research were considered: (1) cancer prediction models and surveillance strategies; (2) tailored IS for cancer recipients; and (3) new adjuvant therapies for HCC recurrence.
Following formulation of several questions, a literature search was undertaken with abstract review followed by article retrieval and full-data extraction. The GRADE system was used for evidence rating incorporating strength of recommendation and quality of evidence.
CITA DEL ARTÍCULO Transplantation. 2020 Mar 23. doi: 10.1097/TP.0000000000003196