Advances in liver transplantation for hepatic malignancies.

Transplant Oncology is an evolving field. While liver transplantation was once contraindicated in patients with cancer, the safety and survival benefit of utilizing transplantation as a curative-intent treatment for primary and metastatic hepatic malignancies has been demonstrated. Currently, liver transplantation is offered to selected patients with hepatocellular carcinoma, perihilar and intrahepatic cholangiocarcinoma, colorectal cancer with isolated liver metastases, and neuroendocrine tumors with isolated liver metastases. We will cover the current inclusion and exclusion criteria and clinical and pathologic factors of each oncologic indication, and future directions in liver transplant oncology.

Successful oncologic outcomes for liver transplantation hinge on careful selection of patients. The evolving role of immunotherapy and targeted tumor therapies have allowed for previously transplant-ineligible patients to be considered for curative-intent transplantation, rather than palliative-intent care. Increasing our knowledge through coordinated multi-institutional studies of each disease process with liver transplantation will be imperative to continue to safely broaden the indications and offer hope to these complex groups of patients. Reframing recipients with oncologic indications for transplant should occur carefully and with attention to rigorous analysis of clinical outcomes.

The objective of this article is to situate the evolving treatments for hepatic malignancies within the expanding scope of transplant oncology. Liver transplantation indications for many primary intrahepatic malignancies as well as colorectal liver metastasis are evolving.The use of immune checkpoint inhibitors in hepatocellular carcinoma demonstrate promise in helping patients achieve aceeptable downstaging in order to reach eligibility for liver transplantation.Colorectal liver metastasis have reemerged as an acceptable indication for liver transplantation in highly selected patients who demonstrate improved survival.The rapid improvements and advances in chemotherapy and immunotherapy will continue to impact the candidacy of patients for transplantation and have the potential to greatly increase transplantation as a viable pathway for cure for malignancies with high rates of cancer-related mortality.