How Far Can We Go with Hepatocellular Carcinoma in Living Donor Liver Transplantation?

Purpose Of Review: Living donor liver transplantation (LDLT) in the setting of hepatocellular carcinoma (HCC) has been adopted worldwide over the past decade. Many centers have implemented LDLT because of the limited supply of deceased organs, which has also provided an opportunity for centers to expand the indication for transplantation for patients with HCC.

Recent Findings: Center-specific expanded HCC criteria have proven to be well tolerated in terms of overall and disease-free survival when compared with the standard, Milan criteria. There is a need to overcome size and number as the sole limiters. New technologies to better predict outcomes after liver transplantation for HCC, response to treatments and/or bridging therapies while waiting for a liver transplantation, along with determining tumour behaviour are being incorporated into criteria. Improved outcomes of LDLT for all causes has increased utilization of the procedure for HCC patients worldwide.

Summary: LDLT has become a great treatment option for HCC patients. Progressively better understanding of tumour behaviour and different surrogates of tumour biology assessments will allow better patient selection for LDLT.