Skip to main content
SpringerLink
Log in

Current Transplant Criteria for Hepatocellular Carcinoma—Overuse or Underuse

  • Hepatic Cancer (N Parikh, Section Editor)
  • Published:
Current Hepatology Reports Aims and scope Submit manuscript

Abstract

In the USA, hepatocellular carcinoma (HCC) has the most rapidly increasing cancer incidence since 1980, has a rate of death that has increased by 43% between 2000 and 2016 and is currently the second most lethal tumor with a 5-year survival of 18%. While the expected 5-year survival after liver transplant (LT) in patients with HCC is attractive at over 70%, LT is limited by extreme shortage of organs and post-LT immunosuppression. Numerous changes to the liver allocation system for HCC in the USA have been applied since 2002. However, for the most part, USA HCC patients continue to receive similar priority for LT despite ample evidence that tumor size and number is only one of many contributors to urgency (i.e. waitlist dropout), utility (i.e. post-LT survival) and LT survival benefit. In this review, we examine where current LT criteria for HCC has resulted in overuse including 1) compensated patients with a single, small, well-treated tumor and 2) patients with HCC amenable to up-front resection. We further examine where current LT criteria for HCC has resulted in underuse including 1) patients with HCC outside of standard criteria but who have favorable markers of tumor biology based on response to local regional therapies, alpha-fetoprotein and other serum biomarker levels, 18F-FDG-PET scan results and tumor biopsy as well as 2) HCC patients with decompensated cirrhosis who have an increased risk of waitlist dropout and thus likely merit additional priority given their increased LT survival benefit.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Abbreviations

AFP:

Alpha-fetoprotein

AASLD:

American Association for the Study of Liver Diseases

HCC:

Hepatocellular carcinoma

ITT:

Intention-to-treat

LT:

Liver transplantation

LRT:

Local-regional therapy

MMaT-3:

Median MELD at transplant minus 3

MMaT/250:

Median MELD at transplant within 250 nautical miles

MELD:

Model for end-stage liver disease

SRTR:

Scientific Registry of Transplant Recipients

TTV:

Total tumor volume

UNOS:

United Network for Organ Sharing

US:

United States

UCSF):

University of California, San Francisco

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Howlader N, Noone AM, Krapcho M, et al. (2019) SEER Cancer Statistics Review, 1975-2016, National Cancer Institute. Bethesda, MD, https://seer.cancer.gov/csr/1975_2016/, based on November 2018 SEER data submission, posted to the SEER web site

  2. Centers for Disease Control and Prevention, National Center for Health Statistics. Trends in liver cancer mortality among adults aged 25 and over in the United States, 2000–2016. July 2018 (https://www.cdcgov/nchs/products/databriefs/db314.htm).

  3. Jemal A, Ward EM, Johnson CJ, et al. Annual Report to the Nation on the Status of Cancer, 1975-2014, Featuring survival. J Natl Cancer Inst 2017;109.

  4. Mazzaferro V, Regalia E, Doci R, et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med. 1996;334:693–9.

    CAS  PubMed  Google Scholar 

  5. Kamath PS, Wiesner RH, Malinchoc M, et al. A model to predict survival in patients with end-stage liver disease. Hepatology. 2001;33:464–70.

    CAS  PubMed  Google Scholar 

  6. Marrero JA, Kulik LM, Sirlin CB, et al. Diagnosis, staging, and management of hepatocellular carcinoma: 2018 Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology. 2018;68:723–50.

    PubMed  Google Scholar 

  7. Freeman RB Jr, Wiesner RH, Roberts JP, McDiarmid S, Dykstra DM, Merion RM. Improving liver allocation: MELD and PELD. Am J Transplant. 2004;4(Suppl 9):114–31.

    PubMed  Google Scholar 

  8. Wiesner RH, Freeman RB, Mulligan DC. Liver transplantation for hepatocellular cancer: the impact of the MELD allocation policy. Gastroenterology. 2004;127:S261–7.

    PubMed  Google Scholar 

  9. Wald C, Russo MW, Heimbach JK, Hussain HK, Pomfret EA, Bruix J. New OPTN/UNOS policy for liver transplant allocation: standardization of liver imaging, diagnosis, classification, and reporting of hepatocellular carcinoma. Radiology. 2013;266:376–82.

    PubMed  Google Scholar 

  10. Heimbach JK, Hirose R, Stock PG, et al. Delayed hepatocellular carcinoma model for end-stage liver disease exception score improves disparity in access to liver transplant in the United States. Hepatology. 2015;61:1643–50.

    PubMed  PubMed Central  Google Scholar 

  11. Washburn K, Edwards E, Harper A, Freeman R. Hepatocellular carcinoma patients are advantaged in the current liver transplant allocation system. Am J Transplant. 2010;10:1643–8.

    CAS  PubMed  Google Scholar 

  12. Organ Procurement and Transplantation Network. Changes to HCC criteria for auto approval. Washington, DC, USA: United States Department of Health and Human Services; 2017; Available at: https://optn.transplant.hrsa.gov/media/1922/liver_hcc_criteria_for_auto_approval_20160815.pdf. [Accessed 20 October 2017].

  13. Hameed B, Mehta N, Sapisochin G, Roberts JP, Yao FY. Alpha-fetoprotein level > 1000 ng/mL as an exclusion criterion for liver transplantation in patients with hepatocellular carcinoma meeting the Milan criteria. Liver Transpl. 2014;20:945–51.

    PubMed  PubMed Central  Google Scholar 

  14. Duvoux C, Roudot-Thoraval F, Decaens T, et al. (2012) Liver transplantation for hepatocellular carcinoma: a model including alpha-fetoprotein improves the performance of Milan criteria. Gastroenterology 143:986–94 e3; quiz e14–5

  15. Levi DM, Tzakis AG, Martin P, et al. Liver transplantation for hepatocellular carcinoma in the model for end-stage liver disease era. J Am Coll Surg. 2010;210:727–34 35-6.

    PubMed  Google Scholar 

  16. Grat M, Krasnodebski M, Patkowski W, et al. Relevance of pre-transplant alpha-fetoprotein dynamics in liver transplantation for hepatocellular cancer. Ann Transplant. 2016;21:115–24.

    CAS  PubMed  Google Scholar 

  17. Hong G, Suh KS, Suh SW, et al. Alpha-fetoprotein and (18)F-FDG positron emission tomography predict tumor recurrence better than Milan criteria in living donor liver transplantation. J Hepatol. 2016;64:852–9.

    CAS  PubMed  Google Scholar 

  18. Toso C, Meeberg G, Hernandez-Alejandro R, et al. Total tumor volume and alpha-fetoprotein for selection of transplant candidates with hepatocellular carcinoma: a prospective validation. Hepatology. 2015;62:158–65.

    CAS  PubMed  Google Scholar 

  19. Ravaioli M, Grazi GL, Piscaglia F, et al. Liver transplantation for hepatocellular carcinoma: results of down-staging in patients initially outside the Milan selection criteria. Am J Transplant. 2008;8:2547–57.

    CAS  PubMed  Google Scholar 

  20. Lai Q, Avolio AW, Manzia TM, et al. Combination of biological and morphological parameters for the selection of patients with hepatocellular carcinoma waiting for liver transplantation. Clin Transpl. 2012;26:E125–31.

    Google Scholar 

  21. Yao FY, Mehta N, Flemming J, et al. Downstaging of hepatocellular cancer before liver transplant: long-term outcome compared to tumors within Milan criteria. Hepatology. 2015;61:1968–77.

    PubMed  PubMed Central  Google Scholar 

  22. Berry K, Ioannou GN. Serum alpha-fetoprotein level independently predicts posttransplant survival in patients with hepatocellular carcinoma. Liver Transpl. 2013;19:634–45.

    PubMed  Google Scholar 

  23. Heimbach JK, Kulik LM, Finn RS, et al. AASLD guidelines for the treatment of hepatocellular carcinoma. Hepatology. 2018;67:358–80.

    PubMed  Google Scholar 

  24. Yao FY, Ferrell L, Bass NM, et al. Liver transplantation for hepatocellular carcinoma: expansion of the tumor size limits does not adversely impact survival. Hepatology. 2001;33:1394–403.

    CAS  PubMed  Google Scholar 

  25. Yao FY, Xiao L, Bass NM, Kerlan R, Ascher NL, Roberts JP. Liver transplantation for hepatocellular carcinoma: validation of the UCSF-expanded criteria based on preoperative imaging. Am J Transplant. 2007;7:2587–96.

    CAS  PubMed  Google Scholar 

  26. Mazzaferro V, Llovet JM, Miceli R, et al. Predicting survival after liver transplantation in patients with hepatocellular carcinoma beyond the Milan criteria: a retrospective, exploratory analysis. Lancet Oncol. 2009;10:35–43.

    PubMed  Google Scholar 

  27. Toso C, Asthana S, Bigam DL, Shapiro AM, Kneteman NM. Reassessing selection criteria prior to liver transplantation for hepatocellular carcinoma utilizing the Scientific Registry of Transplant Recipients database. Hepatology. 2009;49:832–8.

    PubMed  Google Scholar 

  28. Massie AB, Caffo B, Gentry SE, et al. MELD exceptions and rates of waiting list outcomes. Am J Transplant. 2011;11:2362–71.

    CAS  PubMed  PubMed Central  Google Scholar 

  29. Northup PG, Intagliata NM, Shah NL, Pelletier SJ, Berg CL, Argo CK. Excess mortality on the liver transplant waiting list: unintended policy consequences and model for end-stage liver disease (MELD) inflation. Hepatology. 2015;61:285–91.

    PubMed  Google Scholar 

  30. Mehta N, Dodge JL, Hirose R, Roberts JP, Yao FY. Increasing liver transplantation wait-list dropout for hepatocellular carcinoma with widening geographical disparities: implications for organ allocation. Liver Transpl. 2018;24:1346–56.

    PubMed  PubMed Central  Google Scholar 

  31. SRTR Analysis Report, ‘Data Request from the OPTN Liver and Intestinal Organ Transplantation committee.’ Presented December 14, 2016.

  32. Kim WR, Lake JR, Smith JM, et al. OPTN/SRTR 2017 annual data report: liver. Am J Transplant. 2019;19(Suppl 2):184–283.

    PubMed  Google Scholar 

  33. Bruix J, Gores GJ, Mazzaferro V. Hepatocellular carcinoma: clinical frontiers and perspectives. Gut. 2014;63:844–55.

    CAS  PubMed  PubMed Central  Google Scholar 

  34. Berry K, Ioannou GN (2015) Comparison of liver transplant-related survival benefit in patients with versus without hepatocellular carcinoma in the United States. Gastroenterology 149:669–80; quiz e15–6.

  35. Schaubel DE, Guidinger MK, Biggins SW, et al. Survival benefit-based deceased-donor liver allocation. Am J Transplant. 2009;9:970–81.

    CAS  PubMed  PubMed Central  Google Scholar 

  36. Vitale A, Morales RR, Zanus G, et al. Barcelona clinic liver cancer staging and transplant survival benefit for patients with hepatocellular carcinoma: a multicentre, cohort study. Lancet Oncol. 2011;12:654–62.

    PubMed  Google Scholar 

  37. Cillo U, Vitale A, Polacco M, Fasolo E. Liver transplantation for hepatocellular carcinoma through the lens of transplant benefit. Hepatology. 2017;65:1741–8.

    PubMed  Google Scholar 

  38. Halazun KJ, Patzer RE, Rana AA, et al. Standing the test of time: outcomes of a decade of prioritizing patients with hepatocellular carcinoma, results of the UNOS natural geographic experiment. Hepatology. 2014;60:1957–62.

    PubMed  Google Scholar 

  39. Organ Procurement and Transplantation Network. National data: liver transplants 2017. https://optn.transplant.hrsa.gov/data/view-data-reports/national-data/. Accessed July 1, 2018.

  40. Mehta N, Dodge JL, Goel A, Roberts JP, Hirose R, Yao FY. Identification of liver transplant candidates with hepatocellular carcinoma and a very low dropout risk: implications for the current organ allocation policy. Liver Transpl. 2013;19:1343–53.

    PubMed  Google Scholar 

  41. Cucchetti A, Cescon M, Bigonzi E, et al. Priority of candidates with hepatocellular carcinoma awaiting liver transplantation can be reduced after successful bridge therapy. Liver Transpl. 2011;17:1344–54.

    PubMed  Google Scholar 

  42. • Mehta N, Dodge JL, Hirose R, Roberts JP, Yao FY. Predictors of low risk for dropout from the liver transplant waiting list for hepatocellular carcinoma in long wait time regions: Implications for organ allocation. Am J Transplant. 2019;19:2210–8 Using UNOS data, study identified that individuals with hepatocellular carcinoma listed for liver transplant with native MELD-Na less than 15, Child-Turcotte-Pugh class A cirrhosis, single 2 to 3cm lesion and AFP less than 20ng/mL had lower risk of wait-list dropout and therefore may be a group with minimal transplant benefit.

    PubMed  PubMed Central  Google Scholar 

  43. Manzini G, Henne-Bruns D, Porzsolt F, Kremer M. Is there a standard for surgical therapy of hepatocellular carcinoma in healthy and cirrhotic liver? A comparison of eight guidelines BMJ Open Gastroenterol. 2017;4:e000129.

    PubMed  Google Scholar 

  44. Menahem B, Lubrano J, Duvoux C, et al. Liver transplantation versus liver resection for hepatocellular carcinoma in intention to treat: an attempt to perform an ideal meta-analysis. Liver Transpl. 2017;23:836–44.

    PubMed  Google Scholar 

  45. Poon RT, Fan ST, Lo CM, Liu CL, Wong J. Long-term survival and pattern of recurrence after resection of small hepatocellular carcinoma in patients with preserved liver function: implications for a strategy of salvage transplantation. Ann Surg. 2002;235:373–82.

    PubMed  PubMed Central  Google Scholar 

  46. •• Pinna AD, Yang T, Mazzaferro V, et al. Liver Transplantation and Hepatic Resection can Achieve Cure for Hepatocellular Carcinoma. Ann Surg. 2018;268:868–75 Multi-national study comparing liver transplant and hepatic resction for HCC that also projected changes in overall survival based on varying rates of wait-list drop-out. Found that individuals with a single, less than 3cm, HCC with perserved hepatic function who lived in an area where wait-list drop-out was ~20%, overall survival between hepatic resection and liver transplant were similar.

    PubMed  Google Scholar 

  47. Organ Procurement and Transplantation Network. Guidance to liver transplant programs and the national liver review board for: adult meld exceptions for hepatocellular carcinoma (HCC). https://optn.transplant.hrsa.gov/media/2846/liver_guidance_hcc_201706.pdf . Accessed August 15, 2020.

  48. de Haas RJ, Lim C, Bhangui P, et al. Curative salvage liver transplantation in patients with cirrhosis and hepatocellular carcinoma: an intention-to-treat analysis. Hepatology. 2018;67:204–15.

    PubMed  Google Scholar 

  49. Bhangui P, Allard MA, Vibert E, et al. Salvage versus primary liver transplantation for early hepatocellular carcinoma: do both strategies yield similar outcomes? Ann Surg. 2016;264:155–63.

    PubMed  Google Scholar 

  50. Yadav DK, Chen W, Bai X, et al. Salvage liver transplant versus primary liver transplant for patients with hepatocellular carcinoma. Ann Transplant. 2018;23:524–45.

    PubMed  PubMed Central  Google Scholar 

  51. Lee SY, Konstantinidis IT, Eaton AA, et al. Predicting recurrence patterns after resection of hepatocellular cancer. HPB (Oxford). 2014;16:943–53.

    Google Scholar 

  52. Zheng J, Kuk D, Gonen M, et al. Actual 10-year survivors after resection of hepatocellular carcinoma. Ann Surg Oncol. 2017;24:1358–66.

    PubMed  Google Scholar 

  53. Lim KC, Wang VW, Siddiqui FJ, et al. Cost-effectiveness analysis of liver resection versus transplantation for early hepatocellular carcinoma within the Milan criteria. Hepatology. 2015;61:227–37.

    PubMed  Google Scholar 

  54. Clavien PA, Lesurtel M, Bossuyt PM, et al. Recommendations for liver transplantation for hepatocellular carcinoma: an international consensus conference report. Lancet Oncol. 2012;13:e11–22.

    PubMed  Google Scholar 

  55. •• Mazzaferro V, Sposito C, Zhou J, et al. Metroticket 2.0 Model for Analysis of Competing Risks of Death After Liver Transplantation for Hepatocellular Carcinoma. Gastroenterology. 2018;154:128–39 Data driven model called Metroticket 2.0 that predicts competing risks of death after liver transplantation for hepatocellular carcinoma based on AFP and tumor burden parameters.

    PubMed  Google Scholar 

  56. Mehta N, Heimbach J, Harnois DM, et al. Validation of a risk estimation of tumor recurrence after transplant (RETREAT) score for hepatocellular carcinoma recurrence after liver transplant. JAMA Oncol. 2017;3:493–500.

    PubMed  PubMed Central  Google Scholar 

  57. Cillo U, Vitale A, Grigoletto F, et al. Intention-to-treat analysis of liver transplantation in selected, aggressively treated HCC patients exceeding the Milan criteria. Am J Transplant. 2007;7:972–81.

    CAS  PubMed  Google Scholar 

  58. Sapisochin G, Goldaracena N, Laurence JM, et al. The extended Toronto criteria for liver transplantation in patients with hepatocellular carcinoma: a prospective validation study. Hepatology. 2016;64:2077–88.

    PubMed  Google Scholar 

  59. Zheng SS, Xu X, Wu J, et al. Liver transplantation for hepatocellular carcinoma: Hangzhou experiences. Transplantation. 2008;85:1726–32.

    CAS  PubMed  Google Scholar 

  60. Pawlik TM, Delman KA, Vauthey JN, et al. Tumor size predicts vascular invasion and histologic grade: implications for selection of surgical treatment for hepatocellular carcinoma. Liver Transpl. 2005;11:1086–92.

    PubMed  Google Scholar 

  61. Court CM, Harlander-Locke MP, Markovic D, et al. Determination of hepatocellular carcinoma grade by needle biopsy is unreliable for liver transplant candidate selection. Liver Transpl. 2017;23:1123–32.

    PubMed  Google Scholar 

  62. Lee JH, Cho Y, Kim HY, et al. Serum tumor markers provide refined prognostication in selecting liver transplantation candidate for hepatocellular carcinoma patients beyond the Milan criteria. Ann Surg. 2016;263:842–50.

    PubMed  Google Scholar 

  63. Chaiteerakij R, Zhang X, Addissie BD, et al. Combinations of biomarkers and Milan criteria for predicting hepatocellular carcinoma recurrence after liver transplantation. Liver Transpl. 2015;21:599–606.

    PubMed  PubMed Central  Google Scholar 

  64. Hsu CC, Chen CL, Wang CC, et al. Combination of FDG-PET and UCSF criteria for predicting HCC recurrence after living donor liver transplantation. Transplantation. 2016;100:1925–32.

    CAS  PubMed  Google Scholar 

  65. Lee SD, Lee B, Kim SH, et al. Proposal of new expanded selection criteria using total tumor size and (18)F-fluorodeoxyglucose - positron emission tomography/computed tomography for living donor liver transplantation in patients with hepatocellular carcinoma: the National Cancer Center Korea criteria. World J Transplant. 2016;6:411–22.

    PubMed  PubMed Central  Google Scholar 

  66. Kaido T, Ogawa K, Mori A, et al. Usefulness of the Kyoto criteria as expanded selection criteria for liver transplantation for hepatocellular carcinoma. Surgery. 2013;154:1053–60.

    PubMed  Google Scholar 

  67. • Lai Q, Vitale A, Iesari S, et al. Intention-to-treat survival benefit of liver transplantation in patients with hepatocellular cancer. Hepatology. 2017;66:1910–9 European HCC and LT (EurHeCaLT) project showing that in a cohort of over 2,100 individuals with HCC, native MELD score less than or equal to 13 significantly decreased the survival benefit of liver transplantation.

    PubMed  Google Scholar 

  68. Freeman RB, Edwards EB, Harper AM. Waiting list removal rates among patients with chronic and malignant liver diseases. Am J Transplant. 2006;6:1416–21.

    CAS  PubMed  Google Scholar 

  69. Toso C, Dupuis-Lozeron E, Majno P, et al. A model for dropout assessment of candidates with or without hepatocellular carcinoma on a common liver transplant waiting list. Hepatology. 2012;56:149–56.

    PubMed  Google Scholar 

  70. Alver SK, Lorenz DJ, Marvin MR, Brock GN. Projected outcomes of 6-month delay in exception points versus an equivalent model for end-stage liver disease score for hepatocellular carcinoma liver transplant candidates. Liver Transpl. 2016;22:1343–55.

    PubMed  Google Scholar 

  71. Sasaki K, Firl DJ, Hashimoto K, et al. Development and validation of the HALT-HCC score to predict mortality in liver transplant recipients with hepatocellular carcinoma: a retrospective cohort analysis. Lancet Gastroenterol Hepatol. 2017;2:595–603.

    PubMed  Google Scholar 

  72. Brondfield MN, Dodge JL, Hirose R, Heimbach J, Yao FY, Mehta N. Unfair advantages for hepatocellular carcinoma patients listed for liver transplant in short-wait regions following 2015 hepatocellular carcinoma policy change. Liver Transpl. 2020;26:662–72.

    PubMed  Google Scholar 

  73. Kim DJ, Clark PJ, Heimbach J, et al. Recurrence of hepatocellular carcinoma: importance of mRECIST response to chemoembolization and tumor size. Am J Transplant. 2014;14:1383–90.

    CAS  PubMed  Google Scholar 

  74. Lai Q, Avolio AW, Graziadei I, et al. Alpha-fetoprotein and modified response evaluation criteria in solid tumors progression after locoregional therapy as predictors of hepatocellular cancer recurrence and death after transplantation. Liver Transpl. 2013;19:1108–18.

    PubMed  Google Scholar 

  75. Otto G, Herber S, Heise M, et al. Response to transarterial chemoembolization as a biological selection criterion for liver transplantation in hepatocellular carcinoma. Liver Transpl. 2006;12:1260–7.

    PubMed  Google Scholar 

  76. Millonig G, Graziadei IW, Freund MC, et al. Response to preoperative chemoembolization correlates with outcome after liver transplantation in patients with hepatocellular carcinoma. Liver Transpl. 2007;13:272–9.

    PubMed  Google Scholar 

  77. Mehta N, Dodge JL, Grab JD, Yao FY. National experience on down-staging of hepatocellular carcinoma before liver transplant: influence of tumor burden, alpha-fetoprotein, and wait time. Hepatology. 2020;71:943–54.

    CAS  PubMed  Google Scholar 

  78. OPTN. Organ Procurement and Transplantation Network (OPTN) Policies. https://optn.transplant.hrsa.gov/media/1922/liver_hcc_criteria_for_auto_approval_20160815.pdf . Accessed July 22, 2020.

  79. Parikh ND, Waljee AK, Singal AG. Downstaging hepatocellular carcinoma: a systematic review and pooled analysis. Liver Transpl. 2015;21:1142–52.

    PubMed  Google Scholar 

  80. Sinha J, Mehta N, Dodge JL, Poltavskiy E, Roberts J, Yao F. Are there upper limits in tumor burden for down-staging of hepatocellular carcinoma to liver transplant? Analysis of the all-comers protocol. Hepatology. 2019;70:1185–96.

    PubMed  Google Scholar 

  81. Murali AR, Romero-Marrero C, Miller C, et al. Predictors of successful downstaging of hepatocellular carcinoma outside Milan criteria. Transplantation. 2016;100:2391–7.

    CAS  PubMed  Google Scholar 

  82. Lai Q, Vitale A, Halazun K, et al. Identification of an upper limit of tumor burden for downstaging in candidates with hepatocellular cancer waiting for liver transplantation: a west-east collaborative effort. Cancers (Basel). 2020;12.

Download references

Acknowledgments

The authors would like to acknowledge Francis Yao, MD.

Author information

Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Francisco, 513 Parnassus Avenue, Room S-357, San Francisco, CA, 94143-0538, USA

    Varun Saxena & Neil Mehta

  2. Department of Gastroenterology and Hepatology, Kaiser Permanente South San Francisco, South San Francisco, CA, USA

    Varun Saxena

Authors
  1. Varun Saxena
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Neil Mehta
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Neil Mehta.

Ethics declarations

Conflict of Interest

Neil Mehta has served on advisory boards for FujiFilm Wako and received institutional research grant support from FujiFilm WAKO, Glycotest, and Target Pharmasolutions.

Varun Saxena declares no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Hepatic Cancer

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Saxena, V., Mehta, N. Current Transplant Criteria for Hepatocellular Carcinoma—Overuse or Underuse. Curr Hepatology Rep 19, 470–477 (2020). https://doi.org/10.1007/s11901-020-00555-5

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11901-020-00555-5

Keywords

Search

Navigation