# Expanding Indications for Liver Transplantation in the Treatment of Hepatocellular Carcinoma

## TL;DR

Liver transplantation is now being considered for more advanced hepatocellular carcinoma patients due to improved downstaging therapies.

## Contribution

The paper highlights how combination therapies and new treatments are expanding liver transplant eligibility for advanced HCC patients.

## Key findings

- Combination SBRT and TACE is more effective than sorafenib for macrovascular invasion patients.
- LT is now viable for patients with stable disease after local-regional therapy.
- Ruptured HCC patients with prolonged stability can have acceptable transplant outcomes.

## Abstract

Improvements in downstaging therapies have expanded the indications for liver transplantation (LT) for hepatocellular carcinoma (HCC). Patients with more advanced disease are now considered candidates due to advancements in radiation therapy, combination therapies, and immunotherapy. Combination stereotactic body radiation therapy (SBRT) and trans-arterial chemoembolization (TACE) has been shown to be superior to the historic treatment, sorafenib, in patients with macrovascular invasion. These patients are now candidates for LT with stable disease after LRT. Patients with ruptured HCC and prolonged stability have also been shown to have acceptable outcomes. The role of neoadjuvant immunotherapy needs to be further defined and has the potential to further improve tumor control prior to transplant.