Division of Transplant Surgery, Department of Surgery.
Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.
Curr Opin Organ Transplant. 2021 Apr 1;26(2):168-175. doi: 10.1097/MOT.0000000000000866.
Liver transplantation is a standard therapy for certain liver cancers. The majority of liver transplantation in the United States is through deceased donor liver transplantation (DDLT). A significant disparity between the demand of livers and patients awaiting liver transplantation still remains, relying on United Network for Organ Sharing (UNOS) to make policies to determine priority amongst recipients, including for patients with liver cancer. We review the scope of liver transplantation in patients with liver cancer with a focus on hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (iCCA), and unresectable colorectal liver metastases (CRLM) with respect to current liver allocation policy.
Recently, liver allocation changed in the United States. Under the current allocation policy, select patients with HCC and hilar CCA (hCCA) receive priority with an exception score of median MELD score at transplant (MMAT)-3. There is scope for other liver cancers, such as iCCA and CRLM to be considered, as reasonable outcomes have been achieved in these patients outside of the United States through DDLT and living donor liver transplantation (LDLT).
With the growing experience of liver transplantation for nonconventional oncologic indications, the current policy for prioritization of liver cancer within deceased donor liver allocation may need to be re-evaluated.
肝移植是某些肝癌的标准治疗方法。美国大多数肝移植都是通过已故供体肝移植（DDLT）进行的。在美国，肝脏的需求与等待肝移植的患者之间仍然存在显著差距，这依赖于器官共享联合网络（UNOS）制定政策，以确定受者之间的优先顺序，包括肝癌患者。我们回顾了肝癌患者肝移植的范围，重点关注肝细胞癌（HCC）、肝内胆管细胞癌（iCCA）和不可切除的结直肠癌肝转移（CRLM），以及目前的肝脏分配政策。
最近，美国的肝脏分配发生了变化。根据现行分配政策，选择具有 HCC 和肝门部胆管癌（hCCA）的患者，其例外分数为移植时的中位 MELD 评分（MMAT）-3，具有优先权。对于其他肝癌，如 iCCA 和 CRLM，也有考虑的余地，因为在美国以外的地区，通过 DDLT 和活体供体肝移植（LDLT），这些患者已经取得了合理的结果。
随着非传统肿瘤适应证肝移植经验的不断增加，目前在已故供体肝分配中对肝癌进行优先排序的政策可能需要重新评估。
