Liver transplantation for hepatocellular carcinoma: A survey of practices

Erik J.Van Kleek, Jonathan M. Schwartz, Stephen C. Rayhill, Hugo R. Rosen, Scott J. Cotler

Research output: Contribution to journalArticle

10 Scopus citations

Abstract

GOAL: To survey physician practices regarding liver transplantation for patients with hepatocellular carcinoma (HCC). BACKGROUND: Many issues surrounding liver transplantation for HCC are controversial and physician practices have not been well characterized. METHODS: Transplant physicians and surgeons were electronically surveyed regarding surveillance, diagnosis, selection criteria for deceased and living donor transplantation, and use of adjunctive therapy for HCC. RESULTS: Eighty-nine of 174 (51%) physicians completed the survey (39 hepatologists, 41 transplant surgeons, and 9 others). Most respondents were from large US transplant centers. All reported screening for HCC during transplant evaluation, and 98% surveyed patients awaiting transplant. Sixty percent of respondents would biopsy lesions under selective conditions, whereas 32% never biopsy lesions, and 8% biopsy all lesions. Eighty two percent of respondents claimed to adhere to the Milan criteria (single lesion ≤5 cm or no more than 3 lesions each ≤3 cm without vascular invasion) for patient selection, however, 36% would transplant patients with tumors that invade a small portal branch. Forty one percent of respondents would consider living donor transplantation for patients with tumors exceeding the Milan criteria. Ninety-six percent of respondents treat HCC before transplantation, and 87% would transplant patients down-staged to meet the Milan criteria. CONCLUSIONS: There is consistency related to HCC surveillance and treatment in liver transplant candidates. Variations of responses regarding biopsy of lesions, patient selection for deceased donor and living donor transplantation highlight a need for evidence-based guidelines.

Original languageEnglish (US)
Pages (from-to)643-647
Number of pages5
JournalJournal of clinical gastroenterology
Volume40
Issue number7
DOIs
Publication statusPublished - Aug 1 2006

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Keywords

  • Hepatocellular carcinoma
  • Liver transplantation
  • Survey of practices

ASJC Scopus subject areas

  • Gastroenterology

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