Journal of Clinical and Translational Hepatology

Journal of Clinical and Translational Hepatology

Monday, 01 / 24 / 2022




Hepatocellular Carcinoma and the Role of Liver Transplantation: A Review

Haris Muhammad1, Aniqa Tehreem2, Peng-Sheng Ting3, Merve Gurakar4, Sean Young Li5, Cem Simsek3, Saleh A. Alqahtani3, Amy K. Kim3, Ruhail Kohli3 and Ahmet Gurakar3,*

1  Department of Internal Medicine, Greater Baltimore Medical Center, MD, USA
2  Department of Internal Medicine, Sinai Hospital, Baltimore, MD, USA
3  Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
4  Department of Medicine, Osler Residency Program, Johns Hopkins University School of Medicine, Baltimore, MD, USA
5  Duke University, Durham, NC, USA
*Correspondence to:Ahmet Gurakar, Section of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, 720 Rutland Avenue, Ross Research Building, Suite 918 Baltimore, MD 21205, USA. ORCID: . Tel: +1-410-614-3369, Fax: +1-443-683-8349, E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.

Journal of Clinical and Translational Hepatology 2021;9(5):738-748 DOI: 10.14218/JCTH.2021.00125
Received:March 31, 2021 Accepted:May 18, 2021 Published online:June 7, 2021


Hepatocellular carcinoma (HCC) is one of the leading causes of cancer deaths worldwide and liver transplantation (LT) is the only potentially curative treatment. Over the years, Milan criteria has been used for patient selection. There is ongoing research in this field with introduction of new biomarkers for HCC that can help guide future treatment. Furthermore, newer therapies for downstaging of the tumor are being implemented to prevent dropout from the transplant list. In addition, combination therapies for better outcome are under investigation. Interestingly, the concept of living-donor LT and possible use of hepatitis C virus-positive donors has been implemented as an attempt to expand the organ pool. However, there is a conflict of opinion between different centers regarding its efficacy and data is scarce. The aim of this review article is to outline the various selection criteria for LT, discuss the outcomes of LT in HCC patients, and explore future directions of LT for HCC. Therefore, a comprehensive PubMed/MEDLINE review was conducted. To expand our search, references of the retrieved articles were also screened for additional data. After selecting the studies, the authors independently reviewed them to identify the relevant studies. After careful evaluation 120 studies relevant to out topic are cited in the manuscript. Three tables and two figures are also included. In conclusion LT for HCC has evolved over the years. With the introduction of several expanded criteria beyond Milan, the introduction of bridging therapies, such as transcatheter arterial chemoembolization and radiofrequency ablation, and the approval of newer systemic therapies, it is evident that there will be more LT recipients in the future. It is promising to see ongoing trials and the continuous evolution of protocols. Prospective studies are needed to guide the development of a pre-LT criteria that can ensure low HCC recurrence risk and is not overly stringent, clarify the role of LDLT, and determine the optimal bridging therapies to LT.


Hepatocellular carcinoma, Liver transplantation, Model for end-stage liver disease, Trans-arterial radioembolization, Locoregional therapies

Journal of Clinical and Translational Hepatology 2021 vol. 9, 738-748  [ Html  ] [ PDF Full-text ]

© 2021 Authors. This is an Open Access article distributed under the terms of the  Creative Commons Attribution-Noncommercial 4.0 License(CC BY-NC 4.0), permitting all non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.


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