The Role of Liver Transplantation in Hepatocellular Carcinoma

The role of LT for HCC has evolved and expanded in the 3 decades since it was first introduced. However, multiple challenges remain in terms of selecting those patients with the lowest recurrence risk. While several clinical prognostic models have been developed, application of these models is dependent on individual center practices. Precision oncology shows promise-the integration of molecular markers predicting tumor behavior, as well as therapeutic response could enable accurate prognostication and pre transplant therapy. Locoregional and systemic therapy has enabled patients with HCC to be "bridged" or "downstaged", expanding the indications for LT in HCC. With the availability of machine perfusion therapy the utilization of extended criteria donors is expected to increase exponentially. It is hoped that the expansion of the donor pool will meet the increased demand for LT in HCC, while also mitigating disparities in access to transplantation.