The ILTS Consensus Conference on Transplant Oncology: Setting the stage

Abstract

In the early days of liver transplantation (LT), hepatobiliary cancer was the main indication. However, the transplant community realized soon that the results of LT for this indication were dismal and it was abandoned. Professor Mazzaferro et al1 in 1996 revolutionized the indication of LT for hepatocellular carcinoma (HCC) by describing the well-known Milan criteria, which have been the main and most validated criteria to indicate LT for HCC for decades. Subsequently, these criteria have been challenged in many studies as they were considered to be too restrictive. In recent years, the liver transplant community has been revisiting the concept of utilizing LT as a treatment option to cure hepatobiliary malignancies and this has been named Transplant Oncology.2 Several contributing factors to this development should be considered: (1) great improvements in perioperative management of LT recipients and currently postoperative mortality is thought to be <5%, and 1-y survival is ~90%,3 (2) better understanding of immunosuppression and ability to minimize immunosuppression in patients transplanted for cancer without an increase in rejection, (3) several surgical innovations to increase the organ pool (donation after circulatory death, living donation),4,5 (4) discoveries in molecular profiling and systemic therapies in cancer such as colorectal, HCC, or cholangiocarcinoma6,7 that can be used as neoadjuvant therapies, and lastly (5) with the recent introduction of direct acting agents for hepatitis C virus infection that provide curative rates ~100%, the number of patients in need of an LT for decompensated hepatitis C virus have dramatically decreased.8 All of these factors have contributed to revise the concept of Transplant Oncology.