LI-RADS and transplantation for hepatocellular carcinoma
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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.
KeywordsReview article Hepatocellular carcinoma Transplantation Staging Eligibility Prioritization
American Association for the Study of Liver Diseases
American Liver Tumor Study Group
Barcelona Clinic Liver Cancer
Liver Imaging Reporting and Data System
United Network for Organ Sharing
Organ Procurement and Transplantation Network
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.
Compliance with ethical standards
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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