Journal of Liver: Disease & TransplantationISSN: 2325-9612

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Research Article, J Liver Disease Transplant Vol: 5 Issue: 2

Down-Staging Hepatocellular Carcinoma: A Survey of Clinical Practices and Attitudes

Jesse M Civan*, She-Yan Wong, Dina Halegoua-DeMarzio and Steven K Herrine
Department of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia, USA
Corresponding author : Jesse M Civan
Department of Gastroenterology and Hepatology, Thomas Jefferson University, 132 South 10th Street, Suite 480 Main Building, PA 19107, Philadelphia, USA
Tel: 215-503-2146
Received: May 25, 2016 Accepted: June 20, 2016 Published: June 26, 2016
Citation: Civan JM, Wong S, Halegoua-DeMarzio D, Herrine SK (2016) Down-Staging Hepatocellular Carcinoma: A Survey of Clinical Practices and Attitudes. J Liver Disease Transplant 5:2. doi:10.4172/2325-9612.1000139


Hepatocellular carcinoma (HCC) can be cured with liver transplantation, if not exceeding Milan Criteria. “Down-staging” refers to the process of reducing HCC tumor burden, to allow transplant in a patient initially not satisfying these criteria. However, there is no consensus on how down-staging may best be achieved. We conducted an internet-based survey of medical and surgical directors of liver transplant centers nation-wide a series of questions regarding how they practice down-staging, and their attitudes towards these practices. We had a 21.5% response rate to our survey. Although most centers have some formal protocol defining candidacy for downstaging, only about half had a specific threshold in terms of number and size of tumors. The majority of centers did not use AFP levels to define candidacy for down-staging. A sizeable minority of centers did consider patients with portal vein tumor thrombus as candidates for down-staging. Variations in clinical practice of down-staging exist. In the absence of high-quality data on which to base more uniform down-staging protocols, such variation is likely inevitable. Such variation in practice may be beneficial, promoting exploration of the balance between accesses to transplant on one hand, while ensuring adequate post-transplant outcomes on the other hand.

Keywords: Tumor; Transplant; Down staging

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