Improving predictive performance of selection criteria for liver transplantation with hepatocellular carcinoma: combining morphological and biomarker criteria

Liver transplantation (LTx) has become well established internationally as the best treatment option for patients with small unresectable hepatocellular carcinomas (HCC). Our impact and effectiveness in utilizing LTx in the treatment of HCC has been limited mainly by donor availability and by our (in)ability to select the appropriate candidates. This has included both errors of omission (where candidates that may have expected a reasonable long-term survival were ruled out for transplant) and commission (where patients with advanced and/or aggressive tumors have been transplanted only to experience early recurrence and short survival). Initial problems with near open candidacy for HCC in the 1980’s led to poor outcomes (1) and a veritable moratorium that was reversed largely by Mazzaferro’s report of excellent outcomes in a population with tumors tightly selected by size and number (2).