Gonzalo Sapisochin, MD, assistant professor, Division of General Surgery, Department of Surgery, University of Toronto, discusses the benefits of living donor liver transplantation in hepatocellular carcinoma (HCC).

Typically, the best results are achieved when a liver graft is obtained from a living donor because these individuals tend to be fit and healthy, says Sapisochin.

Additionally, living donor transplant can reduce the wait time for individuals on the liver transplant list, explains Sapisochin. Living donation also reduces the risk of a patient becoming ineligible for transplant while they are awaiting a liver from a deceased donor, says Sapisochin.

The health and safety of the living donor is critical during the operation. As such, these procedures should be done in programs that perform a large number of living donations to minimize the risk of donor complications, concludes Sapisochin.

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Gonzalo Sapisochin, MD, discusses the benefits of living donor liver transplantation in hepatocellular carcinoma.

Dr. Sapisochin on the Benefits of Living Donor Transplant in HCC

Gonzalo Sapisochin, MD, assistant professor, Division of General Surgery, Department of Surgery, University of Toronto, discusses factors that help determine transplant eligibility in hepatocellular carcinoma (HCC).

In the United States, the Milan criteria inform which patients are eligible for liver transplantation, says Sapisochin. Patients are eligible for transplant if they have a single tumor diameter <5 cm, ≤3 foci of tumor, each one ≤3 cm, no angioinvasion, and no extrahepatic involvement.

Protocols including transarterial chemoembolization can help down-stage patients and allow those with slightly larger tumors to become transplant eligible, explains Sapisochin.

At the University of Toronto, factors beyond the size and extent of the tumor, which take into account the heterogeneity of the tumor, may influence a patient’s eligibility status, says Sapisochin. These include the tumor biology and alpha fetoprotein levels. Notably, there are not as many limitations to transplant for patients with living donors, concludes Sapisochin.

Gonzalo Sapisochin, MD, discusses factors that help determine transplant eligibility in hepatocellular carcinoma.

Dr. Sapisochin on Determining Transplant Eligibility in HCC

Gonzalo Sapisochin, MD, assistant professor of surgery, University of Toronto, discusses neoadjuvant treatment for patients with hepatocellular carcinoma (HCC).

It’s important to treat patients while they are awaiting liver transplant to make sure the tumor doesn’t progress in a way that will hinder the procedure, Sapisochin says. Mainly, there are criteria in terms of allowable tumor size heading into the transplant. Unless a living donor is being utilized, patients will go on a waiting list, with the average wait time depending on the hospital’s jurisdiction. Usually, the waiting period will be 6 months to 1 year.

An optimal chemotherapy regimen for this setting is not yet clear. There are ongoing studies looking at this issue, but there has never been a phase III trial comparing “bridging therapies.” The evidence for each therapy is still weak. Sapisochin says the decision relies heavily on Barcelona Clinic Liver Cancer staging, tumor burden, and level of liver disease.

Articles

Gonzalo Sapisochin, MD, assistant professor of surgery, University of Toronto, discusses neoadjuvant treatment for patients with hepatocellular carcinoma.

Gonzalo Sapisochin, MD

Articles

Dr. Sapisochin on the Benefits of Living Donor Transplant in HCC

Dr. Sapisochin on Determining Transplant Eligibility in HCC

Dr. Sapisochin on Neoadjuvant Treatment for HCC