Dr. Sapisochin on Determining Transplant Eligibility 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.