Julie K. Heimbach, MD, transplant surgeon, surgical director of Liver Transplantation, Mayo Clinic, discusses the need for multidisciplinary care in patients with hepatocellular carcinoma (HCC).

A unique aspect of HCC is that patients often have underlying liver disease, commonly cirrhotic liver disease, and so a multidisciplinary treatment approach is necessary, according to Heimbach. For example, oncology experts are needed to treat the liver with systemic therapy, and radiologists are needed to administer liver-directed treatment, Heimbach says. Furthermore, surgical teams may be needed for transplant and resection in these patients, Heimbach adds. 

Treatment decisions depend on tumor characteristics, underlying liver disease characteristics, and systemic comorbidities, Heimbach adds. As such, a multidisciplinary team is needed to determine the best approach for each patient, Heimbach concludes.

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Julie K. Heimbach, MD, discusses the need for multidisciplinary care in patients with hepatocellular carcinoma.

Dr. Heimbach on the Need for Multidisciplinary Care in HCC 

Julie K. Heimbach, MD, a transplant surgeon and the surgical director of Liver Transplantation at Mayo Clinic, discusses the criteria for liver transplantation in patients with hepatocellular carcinoma (HCC).

Numerous changes in liver transplantation criteria have taken place over several years, both overall and specific to HCC, according to Heimbach. These changes began in 2018 when standard downstaging criteria were adopted. Previously, patients who were outside of standard Milan criteria had to go through an appeal process in order to undergo transplant, but this is no longer the case, says Heimbach. Patients who are outside of the Milan criteria but have been successfully downstaged can now go through a standard process for transplant, she explains.

Additionally, another policy change was adopted for patients with exceptions in HCC, which comprises approximately 70% of the exceptions. 

Thus far, a standard patient with HCC who is meeting transplant criteria and is going to have an exception previously were given a score that increased every 3 months, she says. Since May 2020, if a patient is given a score that has started just below the median where they were offered transplant, their score stays there, Heimbach says. While it starts higher than it used to, it doesn't go up, Heimbach concludes.

Julie K. Heimbach, MD, discusses the criteria for liver transplantation in patients with hepatocellular carcinoma.

Julie K. Heimbach, MD

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Dr. Heimbach on the Need for Multidisciplinary Care in HCC

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