Therapeutic Approach to Post-Transplant Recurrence of Hepatocellular Carcinoma: Certainties and Open Issues

• Published in: Cancers Vol. 15; no. 23; p. 5593
• Main Authors: Marrone, Giuseppe, Leone, Maria Sandrina, Biolato, Marco, Liguori, Antonio, Bianco, Giuseppe, Spoletini, Gabriele, Gasbarrini, Antonio, Miele, Luca, Pompili, Maurizio
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 26.11.2023
• Subjects: B cells; Biopsy; Care and treatment; Diseases; Drug interaction; Graft rejection; Health aspects; Hepatocellular carcinoma; Hepatoma; Histology; Immunosuppression; Immunosuppressive agents; Immunotherapy; Liver; Liver cancer; Liver cirrhosis; Liver transplantation; Liver transplants; Localization; Medical prognosis; Metastasis; Morphology; Patients; Prediction models; Prognosis; Relapse; Surveillance; Transplantation; Tumors; HCC recurrence; mTOR inhibitors; vascular invasion; checkpoint inhibitors; liver transplantation
• ISSN: 2072-6694; 2072-6694
• DOI: 10.3390/cancers15235593

Hepatocellular carcinoma (HCC) is a growing indication for liver transplantation (LT). Careful candidate selection is a prerequisite to keep post-LT recurrence rates within acceptable percentages. In the pre-LT period, various types of locoregional treatments and/or systemic therapies can be used for bridging or downstaging purposes. In this context, one of the factors limiting the possibility of treatment is the degree of functional liver impairment. In the LT subject, no widely accepted indications are available to guide treatment of disease recurrence and heterogeneity exists between transplant centers. Improved liver function post LT makes multiple therapeutic strategies theoretically feasible, but patient management is complicated by the need to adjust immunosuppressive therapy and to assess potential toxicities and drug–drug interactions. Finally, there is controversy and uncertainty about the use of recently introduced immunotherapeutic drugs, mainly due to the risk of organ rejection. In this paper, we will review the most recent available literature on the management of post-transplant HCC recurrence, discussing evidence and controversies.