Dr. Heimbach on Liver Transplant Criteria 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.