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J Clin Gastroenterol. 2006 Aug;40(7):643-7.

Liver transplantation for hepatocellular carcinoma: a survey of practices.

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1
Department of Internal Medicine, Oregon Health and Sciences University, Portland, OR 97239, USA.

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.

PMID:
16917411
[Indexed for MEDLINE]
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