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LI-RADS and transplantation for hepatocellular carcinoma

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Abstract

Patients with hepatocellular carcinoma (HCC) may be eligible for liver transplantation. Liver transplant candidates with HCC compete for the same deceased donor organs as those without HCC. These scarce organs must be allocated fairly and justly to those who will benefit most. Unlike most other cancers, HCC is often diagnosed noninvasively by imaging without biopsy confirmation. Therefore, radiologists play an important role in diagnosing definite HCC (i.e., LR-5 category) that counts toward staging and determination of liver transplant eligibility. This review explains the conversion of LI-RADS observation categories to organ procurement and transplantation network classes, illustrates the radiologic T-staging systems, reviews selection criteria for liver transplant eligibility, and discusses prioritization of liver transplant candidates with HCC. In addition, this review summarizes imaging requirements, including contrast agents accepted, minimum specifications for dynamic CT or MRI of the liver, and modalities accepted for assessment of extrahepatic spread or metastatic disease in liver transplant candidates with HCC.

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Abbreviations

AASLD:

American Association for the Study of Liver Diseases

ALTS:

American Liver Tumor Study Group

BCLC:

Barcelona Clinic Liver Cancer

HCC:

Hepatocellular Carcinoma

LI-RADS:

Liver Imaging Reporting and Data System

UNOS:

United Network for Organ Sharing

OPTN:

Organ Procurement and Transplantation Network

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Acknowledgements

This work was supported by (1) the Fonds de recherche du Québec—Santé (Career Award #26993), and (2) New Researcher Startup Grant from the Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM) to An Tang.

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Authors and Affiliations

  1. Department of Radiology, Radio-oncology and Nuclear Medicine, University of Montreal and CRCHUM, 1058 rue Saint-Denis, Montréal, QC, H2X 3J4, Canada

    An Tang

  2. Department of Radiology, Washington University, St. Louis, MO, USA

    Kathryn J. Fowler

  3. Department of Radiology, Montefiore Medical Center, Bronx, NY, USA

    Victoria Chernyak

  4. Department of Surgery, Washington University, St. Louis, MO, USA

    William C. Chapman

  5. Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, CA, USA

    Claude B. Sirlin

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  1. An Tang
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  2. Kathryn J. Fowler
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Correspondence to An Tang.

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Disclosures

An Tang: Advisory Board of Imagia Cybernetics. Kathryn J. Fowler and Victoria Chernyak have nothing to disclose. William Chapman: Scientific Advisory Board of Novartis Pharmaceutical. Founder of Pathfinder Therapeutics. Claude B. Sirlin: Industry research grants Bayer, Guerbet, Siemens, GE, Philips, Supersonic, Arterys. Consulting and service agreements Alexion, AstraZeneca, Bioclinica, BMS, Bracco, Celgene, Fibrogen, Galmed, Genentech, Genzyme, Gilead, Icon, Intercept, Isis, Janssen, NuSirt, Perspectum, Pfizer, Profil, Sanofi, Shire, Synageva, Tobira, Takeda, Virtual Scopics.

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Tang, A., Fowler, K.J., Chernyak, V. et al. LI-RADS and transplantation for hepatocellular carcinoma. Abdom Radiol 43, 193–202 (2018). https://doi.org/10.1007/s00261-017-1210-8

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  • DOI: https://doi.org/10.1007/s00261-017-1210-8

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