Affiliation(s): University of Milan and National Cancer Institute of Milan
Hepatocellular carcinoma (HCC) has become a leading indication to liver transplantation (LT) even if LT for HCC remains an unfinished product searching for perfection. The recent introduction of effective anti-hepatitis C virus (HCV) agents together with the practice to down-stage tumors originally thought to be ineligible for transplantation is increasing the number of HCCs within the transplant waiting-lists and the consequent competition between cancer and non-cancer indications in the current scenario of persistent organ shortage. Cancer vs. non-cancer conditions are known to affect post-transplant outcome of individual patients, as various competing features weight differently in determining patients survival. In the last two decades, several selection criteria for HCC have been developed on pre-transplant staging, explant pathology, biomarkers such as alpha-fetoprotein (AFP) and response to pre-transplant neoadjuvant therapies. Advancement in the treatment of HCC have produced significantly longer survival expectations in case of tumor recurrence also in the transplant contest.
The obviously curative potential of LT for HCC has limited the construction of an evidence-based framework around this indication and therefore the elucidation of mechanisms that occur in the natural history of LT for HCC remains a major challenge. As LT remains a cornerstone upon which science, patient care, ethics, health economy and organization matters rely and grow, the ultimate endpoint for the transplant community is to improve HCC treatment and clinical outcome. Most of the progress made in this exciting perspective will be described.
Prof Vincenzo Mazzaferro bio:
Vincenzo Mazzaferro received his M.D. degree at the University of Turin and the Ph.D. in Surgery and Oncology at the University of Milan in Italy. He was a postdoctoral fellow and then staff at the Department of Surgery and Transplantation at the University of Pittsburgh (United States) under the direction of prof. T.E. Starzl. In 1991 he joined the first Italian comprehensive cancer center (Istituto Nazionale Tumori IRCCS) in Milan, where he started a liver transplant program focused on hepatocellular carcinoma and leaded since then a team that pioneered the multifaced modern approach to hepato-oncology. In 1996 he published in the New England Journal of Medicine the first prospective study on liver transplantation for HCC, establishing the so-called Milan Criteria later incorporated in all staging systems of HCC and still endorsed by Eastern and Western guidelines. Starting from 2000, as the Director of HPB Surgery and Liver Transplantation and Professor of Surgery at the University of Milan he has contributed to cutting-edge research on innovation of surgical, interventional, and pharmacologic treatments of hepato-biliary malignancies, together with translational applications of surgical approach and liver transplantation to oncology and hepatology.
He owns a significant publication record and a large number of international collaborations. He received numerous awards by the Italian Association of Cancer Research, the Société Française de Chirurgie Digestive, the American Association of Cancer Research, the Cardiovascular and Interventional Radiological Society of Europe and the City of Milan. He has served as Associate Editor for the Journal of Hepatology and is a member of several major editorial and scientific boards, including the EASL clinical practice guidelines on hepatocellular carcinoma.