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Article: Multidisciplinary approach for post-liver transplant recurrence of hepatocellular carcinoma: A proposed management algorithm
Title | Multidisciplinary approach for post-liver transplant recurrence of hepatocellular carcinoma: A proposed management algorithm |
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Authors | |
Keywords | Hepatocellular carcinoma Recurrence Liver transplantation |
Issue Date | 2018 |
Publisher | Baishideng Publishing Group. The Journal's web site is located at http://www.wjgnet.com/1007-9327/index.htm |
Citation | World Journal of Gastroenterology, 2018, v. 24 n. 45, p. 5081-5094 How to Cite? |
Abstract | A large number of liver transplants have been performed for hepatocellular carcinoma (HCC), and recurrence is increasingly encountered. The recurrence of HCC after liver transplantation is notoriously difficult to manage. We hereby propose multi-disciplinary management with a systematic approach. The patient is jointly managed by the transplant surgeon, physician, oncologist and radiologist. Immunosuppressants should be tapered to the lowest effective dose to protect against rejection. The combination of a mammalian target of rapamycin inhibitor with a reduced calcineurin inhibitor could be considered with close monitoring of graft function and toxicity. Comprehensive staging can be performed by dual-tracer positron emission tomography-computed tomography or the combination of contrast computed tomography and a bone scan. In patients with disseminated recurrence, sorafenib confers survival benefits but is associated with significant drug toxicity. Oligo-recurrence encompasses recurrent disease that is limited in number and location so that loco-regional treatments convey disease control and survival benefits. Intra-hepatic recurrence can be managed with graft resection, but significant operative morbidity is expected. Radiofrequency ablation and stereotactic body radiation therapy (SBRT) are effective alternative strategies. In patients with more advanced hepatic disease, regional treatment with trans-arterial chemoembolization or intra-arterial Yttrium-90 can be considered. For patients with extra-hepatic oligo-recurrence, loco-regional treatment can be considered if practical. Patients with more than one site of recurrence are not always contraindicated for curative treatments. Surgical resection is effective for patients with pulmonary oligo-recurrence, but adequate lung function is a pre-requisite. SBRT is a non-invasive and effective modality that conveys local control to pulmonary and skeletal oligo-recurrences. |
Persistent Identifier | http://hdl.handle.net/10722/271292 |
ISSN | 2023 Impact Factor: 4.3 2023 SCImago Journal Rankings: 1.063 |
PubMed Central ID | |
ISI Accession Number ID |
DC Field | Value | Language |
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dc.contributor.author | Au, KP | - |
dc.contributor.author | Chok, KSH | - |
dc.date.accessioned | 2019-06-24T01:07:04Z | - |
dc.date.available | 2019-06-24T01:07:04Z | - |
dc.date.issued | 2018 | - |
dc.identifier.citation | World Journal of Gastroenterology, 2018, v. 24 n. 45, p. 5081-5094 | - |
dc.identifier.issn | 1007-9327 | - |
dc.identifier.uri | http://hdl.handle.net/10722/271292 | - |
dc.description.abstract | A large number of liver transplants have been performed for hepatocellular carcinoma (HCC), and recurrence is increasingly encountered. The recurrence of HCC after liver transplantation is notoriously difficult to manage. We hereby propose multi-disciplinary management with a systematic approach. The patient is jointly managed by the transplant surgeon, physician, oncologist and radiologist. Immunosuppressants should be tapered to the lowest effective dose to protect against rejection. The combination of a mammalian target of rapamycin inhibitor with a reduced calcineurin inhibitor could be considered with close monitoring of graft function and toxicity. Comprehensive staging can be performed by dual-tracer positron emission tomography-computed tomography or the combination of contrast computed tomography and a bone scan. In patients with disseminated recurrence, sorafenib confers survival benefits but is associated with significant drug toxicity. Oligo-recurrence encompasses recurrent disease that is limited in number and location so that loco-regional treatments convey disease control and survival benefits. Intra-hepatic recurrence can be managed with graft resection, but significant operative morbidity is expected. Radiofrequency ablation and stereotactic body radiation therapy (SBRT) are effective alternative strategies. In patients with more advanced hepatic disease, regional treatment with trans-arterial chemoembolization or intra-arterial Yttrium-90 can be considered. For patients with extra-hepatic oligo-recurrence, loco-regional treatment can be considered if practical. Patients with more than one site of recurrence are not always contraindicated for curative treatments. Surgical resection is effective for patients with pulmonary oligo-recurrence, but adequate lung function is a pre-requisite. SBRT is a non-invasive and effective modality that conveys local control to pulmonary and skeletal oligo-recurrences. | - |
dc.language | eng | - |
dc.publisher | Baishideng Publishing Group. The Journal's web site is located at http://www.wjgnet.com/1007-9327/index.htm | - |
dc.relation.ispartof | World Journal of Gastroenterology | - |
dc.rights | This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. | - |
dc.subject | Hepatocellular carcinoma | - |
dc.subject | Recurrence | - |
dc.subject | Liver transplantation | - |
dc.title | Multidisciplinary approach for post-liver transplant recurrence of hepatocellular carcinoma: A proposed management algorithm | - |
dc.type | Article | - |
dc.identifier.email | Chok, KSH: chok6275@hku.hk | - |
dc.identifier.authority | Chok, KSH=rp02110 | - |
dc.description.nature | published_or_final_version | - |
dc.identifier.doi | 10.3748/wjg.v24.i45.5081 | - |
dc.identifier.pmid | 30568386 | - |
dc.identifier.pmcid | PMC6288653 | - |
dc.identifier.scopus | eid_2-s2.0-85058176659 | - |
dc.identifier.hkuros | 297975 | - |
dc.identifier.volume | 24 | - |
dc.identifier.issue | 45 | - |
dc.identifier.spage | 5081 | - |
dc.identifier.epage | 5094 | - |
dc.identifier.isi | WOS:000452759500004 | - |
dc.publisher.place | United States | - |
dc.identifier.issnl | 1007-9327 | - |