Transplant Center, University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229, USA.
Curr Opin Organ Transplant. 2011 Jun;16(3):297-300. doi: 10.1097/MOT.0b013e3283465756.
Hepatocelluar carcinoma (HCC) continues to grow in scope and magnitude as a clinical entity. Liver transplantation has been shown to be a potentially curative treatment for a select group of patients with HCC. The role of liver transplantation as part of the multidisciplinary treatment of HCC continues to evolve.
The use of liver transplantation as treatment for HCC continues to grow as selection criteria are refined to optimize outcomes. The Milan criteria (T2) are considered the standard selection criteria but have been challenged in recent years as being too limiting. Treatment for HCC patients awaiting liver transplantation includes a number of ablative techniques that may arrest tumor growth. Similar treatments may potentially downsize large (>T2) HCC so that they fall into the exception criteria for liver transplantation (downstaging), which is an area of ongoing study. Prioritizing HCC patients on the liver transplantation waiting list remains a difficult balance with non-HCC patients. After several downward adjustments of priority for HCC patients, the current system of awarding set, defined priority scores with time-dependent increases for HCC patients who remain within Milan criteria (compared to a continuous priority scale for non-HCC patients), continues to give HCC patients excess priority in access to liver transplantation. Despite this, outcomes for HCC patients remain inferior to non-HCC patients after liver transplantation.
Liver transplantation remains an acceptable treatment for select HCC patients. Optimizing patient selection and pretransplant treatment, and refining prioritization in relation to non-HCC patients for these scarce resource cadaveric livers continues to challenge the transplant community.
肝癌（HCC）作为一种临床实体，其范围和规模仍在不断扩大。肝移植已被证明是治疗特定 HCC 患者的一种潜在治愈方法。肝移植作为 HCC 多学科治疗的一部分的作用仍在不断发展。
随着选择标准的不断完善，以优化结果，肝移植作为 HCC 治疗方法的应用继续增加。米兰标准（T2）被认为是标准的选择标准，但近年来，由于其限制过于严格而受到挑战。等待肝移植的 HCC 患者的治疗包括多种消融技术，这些技术可能会阻止肿瘤生长。类似的治疗方法可能会潜在地使较大的 HCC（>T2）缩小，从而使其落入肝移植的例外标准（降期），这是一个正在研究的领域。在肝移植等待名单上为 HCC 患者确定优先级仍然是一个困难的平衡，需要考虑非 HCC 患者。在对 HCC 患者的优先级进行了几次下调后，目前的系统是为符合米兰标准（与非 HCC 患者的连续优先级相比，为符合米兰标准的 HCC 患者设定固定的、有时间依赖性增加的优先级得分）的 HCC 患者授予固定的优先级得分，继续为 HCC 患者在获得肝移植方面提供过多的优先级。尽管如此，HCC 患者在肝移植后的结果仍劣于非 HCC 患者。
肝移植仍然是治疗某些 HCC 患者的可接受方法。优化患者选择和移植前治疗，并在与非 HCC 患者相比，对这些稀缺资源尸体肝脏进行与 HCC 患者相关的优先级排序，这仍然是移植界面临的挑战。
