Hepatocellular carcinoma (HCC) is the leading primary liver tumor and a main indication
for transplant. Transplant criteria are based on clinicopathologic features, meanwhile
adequate downstaging and molecular mechanisms are getting more attention in evolving
therapeutic algorithm of HCC. The aim of our study was to overview the results of
the Hungarian Liver Transplant Program in the field of HCC and introduce new aspects
of personalized treatment options.We performed retrospective analysis of survival
and tumor recurrence of HCC-associated liver transplant recipients between October
2013 and December 2020. Patients were categorized in Milan criteria (MC), beyond MC
but within University of California, San Francisco (UCSF), and beyond UCSF criteria
groups after pathologic examination of the explanted liver. Demographic data and preoperative
locoregional treatments were assessed.A total of 529 primer liver transplants were
performed, 88 because of HCC. A total of 87 patients had underlying cirrhosis because
of hepatitis C (54%), alcohol-related liver disease (33.7%), hepatitis B (4.5%), or
unknown etiology. A total of 55.6% of the patients had at least one locoregional treatment.
A total of 67.4% of the patients were within MC, 5.6% were within UCSF criteria, and
27% were beyond UCSF criteria. The 1-, 3-, and 5-year survival rates were 80%, 79%,
and 75%. The outcome was better in early-stage tumors, but the difference was not
significant (P = .745) CONCLUSIONS: The favorable survival in our department legitimates
the strict transplant criteria of HCC. Adequate locoregional therapy as downstaging
can expand recipient pool. Molecular tumor profiling may lead to personalized treatment
of HCC.
