Liver Transplantation for Hepatoma: Raising the Bar

Purpose of Review: Ever since the birth of liver transplantation, cancer has played a major role in the advances to the field. With improved outcomes came increasing demands on a limited organ supply and the need for policy development to guide organ allocation. This is an attempt to summarize important milestones in the practice and policy developments over the past 50 years with a nod to our collective ability to continue to improve the field of transplantation, care of liver cancer, and value of that gift of life—the donor liver. Recent Findings: The most recent Organ Procurement and Transplantation Network (OPTN) Policy changes further improve liver allocation to cancer candidates with a focus on (1) current hepatocellular cancer (HCC) size and number, (2) downstaging criteria, and (3) AFP limits and will help to better achieve equitable allocation of livers to HCC and non-HCC candidates needing transplantation using objective real-time evidence to base our practice. Summary: We, as a community have and despite our individual needs and patterns, have shown how data collection, review, and discussion can lead to best practice at a grand scale. From its first days as a procedure to our current state of expertise, liver transplantation for HCC remains a classic example of evidence-based practice.