Current challenges in liver transplantation for hepatocellular carcinoma

Best Practice and Research: Clinical Gastroenterology

Volumn 28, Issue 5, 2014, Pages 867-879

  Bhoori, Sherrie ^a   Mazzaferro, Vincenzo ^a  

^a NATIONAL CANCER INSTITUTE   (Italy)

Author keywords

Allocation; Bridging; Downstaging; Hepatocellular carcinoma; Immunosuppression; Liver transplantation; Patient selection; Post transplantation recurrence

Indexed keywords

CYCLOSPORIN; DACLIZUMAB; INTERLEUKIN 2 RECEPTOR; INTERLEUKIN 2 RECEPTOR ANTIBODY; TACROLIMUS;

CANCER PATIENT; CANCER PROGNOSIS; CANCER RECURRENCE; CANCER THERAPY; CHEMOEMBOLIZATION; CONTROLLED CLINICAL TRIAL (TOPIC); COST EFFECTIVENESS ANALYSIS; DNA REPAIR; GENETIC PREDISPOSITION; GRAFT RECIPIENT; GRAFT SURVIVAL; HUMAN; HUMAN TISSUE; IMMUNOSUPPRESSIVE TREATMENT; INTENTION TO TREAT ANALYSIS; INTERNATIONAL NORMALIZED RATIO; LIVER CELL CARCINOMA; LIVER GRAFT; LIVER TRANSPLANTATION; LIVER WEIGHT; LIVING DONOR; LONG TERM SURVIVAL; ORGAN TRANSPLANTATION; PATIENT SELECTION; QUALITY OF LIFE; RADIOFREQUENCY ABLATION; REVIEW; SCORING SYSTEM; SURVIVAL RATE; TUMOR DIFFERENTIATION; TUMOR GROWTH; TUMOR RECURRENCE; TUMOR VOLUME; CARCINOMA, HEPATOCELLULAR; HOSPITAL ADMISSION; LIVER NEOPLASMS; PATHOLOGY; RESOURCE ALLOCATION;

CARCINOMA, HEPATOCELLULAR; HUMANS; LIVER NEOPLASMS; LIVER TRANSPLANTATION; PATIENT SELECTION; RESOURCE ALLOCATION; WAITING LISTS;

EID: 84921758736     PISSN: 15216918     EISSN: 15321916     Source Type: Journal    
DOI: 10.1016/j.bpg.2014.08.001     Document Type: Review

References (96)

1. Starzl TE. The saga of liver replacement, with particular reference to the reciprocal influence of liver and kidney transplantation (1955-1967) . J Am Coll Surg 2002; 195: 587-610.
2. Starzl TE, Porter KA, Brettschneider L, Penn I, Bell P, Putnam CW, et al. Clinical and pathologic observations after orthotopic transplantation of the human liver. Surg Gynecol Obstet 1969; 128: 327-39.
3. Penn I. Hepatic transplantation for primary and metastatic cancers of the liver. Surgery 1991; 110: 726-34.
4. Mazzaferro V, Regalia E, Doci R, Andreola S, Pulvirenti A, Bozzetti F, et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med 1996; 334: 693-9.
5. Mazzaferro V, Bhoori S, Sposito C, Bongini M, Langer M, Miceli R, et al. Milan criteria in liver transplantation for hepatocellular carcinoma: An evidence-based analysis of 15 years of experience. Liver Transpl 2011; 17: S44-57.
6. De Vreede I, Steers JL, Burch PA, Rosen CB, Gunderson LL, Haddock MG, et al. Prolonged disease-free survival after orthotopic liver transplantation plus adjuvant chemoirradiation for cholangiocarcinoma. Liver Transpl 2000; 6: 309-16.
7. Schmeding M, Neumann UP. Liver transplantation for intra-and extrahepatic cholangiocarcinoma. Ann Transplant 2013; 18: 1-8.
8. Cruz Jr. RJ, Ranganathan S, Mazariegos G, Soltys K, Nayyar N, Sun Q, et al. Analysis of national and single-center incidence and survival after liver transplantation for hepatoblastoma: New trends and future opportunities. Surgery 2013; 153: 150-9.
9. Mehrabi A, Kashfi A, Fonouni H, Schemmer P, Schmied BM, Hallscheidt P, et al. Primary malignant hepatic epithelioid hemangioendothelioma: A comprehensive review of the literature with emphasis on the surgical therapy. Cancer 2006; 107: 2108-21.
10. Mazzaferro V, Pulvirenti A, Coppa J. Neuroendocrine tumors metastatic to the liver: How to select patients for liver transplantation? J Hepatol 2007; 47: 460-6.
11. Le Treut YP, Gregoire E, Belghiti J, Boillot O, Soubrane O, Mantion G, et al. Predictors of long-term survival after liver transplantation for metastatic endocrine tumors: An 85-case French multicentric report. Am J Transplant 2008; 8: 1205-13.
12. Fan ST, Le Treut YP, Mazzaferro V, Burroughs AK, Olausson M, Breitenstein S, et al. Liver transplantation for neuroendocrine tumour liver metastases. HPB (Oxford) 2014. http://dx.doi.org/10.1111/hpb.12308 [in press].
13. Frilling A, Modlin IM, Kidd M, Russell C, Breitenstein S, Salem R, et al. Recommendations for management of patients with neuroendocrine liver metastases. Lancet Oncol 2014; 15: E8-21.
14. Mittal S, El-Serag HB. Epidemiology of hepatocellular carcinoma: Consider the population. J Clin Gastroenterol 2013; 47: S2-6.
15. El-Serag HB. Epidemiology of viral hepatitis and hepatocellular carcinoma. Gastroenterology 2012; 142: 1264-73. e1261.
16. Blachier M, Leleu H, Peck-Radosavljevic M, Valla DC, Roudot-Thoraval F. The burden of liver disease in Europe: A review of available epidemiological data. J Hepatol 2013; 58: 593-608.
17. Marsh JW, Dvorchik I. Liver organ allocation for hepatocellular carcinoma: Are we sure? Liver Transpl 2003; 9: 693-6.
18. Yao FY, Ferrell L, Bass NM, Watson JJ, Bacchetti P, Venook A, et al. Liver transplantation for hepatocellular carcinoma: Expansion of the tumor size limits does not adversely impact survival. Hepatology 2001; 33: 1394-403.
19. Herrero JI, Sangro B, Quiroga J, Pardo F, Herraiz M, Cienfuegos JA, et al. Influence of tumor characteristics on the outcome of liver transplantation among patients with liver cirrhosis and hepatocellular carcinoma. Liver Transpl 2001; 7: 631-6.
20. Onaca N, Davis GL, Goldstein RM, Jennings LW, Klintmalm GB. Expanded criteria for liver transplantation in patients with hepatocellular carcinoma: A report from the International Registry of Hepatic Tumors in Liver Transplantation. Liver Transpl 2007; 13: 391-9.
21. Jonas S, Mittler J, Pascher A, Schumacher G, Theruvath T, Benckert C, et al. Living donor liver transplantation of the right lobe for hepatocellular carcinoma in cirrhosis in a European center. Liver Transpl 2007; 13: 896-903.
22. Takada Y, Ito T, Ueda M, Sakamoto S, Haga H, Maetani Y, et al. Living donor liver transplantation for patients with HCC exceeding the Milan criteria: A proposal of expanded criteria. Dig Dis 2007; 25: 299-302.
23. Soejima Y, Taketomi A, Yoshizumi T, Uchiyama H, Aishima S, Terashi T, et al. Extended indication for living donor liver transplantation in patients with hepatocellular carcinoma. Transplantation 2007; 83: 893-9.
24. Sugawara Y, Tamura S, Makuuchi M. Living donor liver transplantation for hepatocellular carcinoma: Tokyo University series. Dig Dis 2007; 25: 310-2.
25. Zheng SS, Xu X, Wu J, Chen J, Wang WL, Zhang M, et al. Liver transplantation for hepatocellular carcinoma: Hangzhou experiences. Transplantation 2008; 85: 1726-32.
26. Lee SG, Hwang S, Moon DB, Ahn CS, Kim KH, Sung KB, et al. Expanded indication criteria of living donor liver transplantation for hepatocellular carcinoma at one large-volume center. Liver Transpl 2008; 14: 935-45.
27. Silva M, Moya A, Berenguer M, Sanjuan F, Lopez-Andujar R, Pareja E, et al. Expanded criteria for liver transplantation in patients with cirrhosis and hepatocellular carcinoma. Liver Transpl 2008; 14: 1449-60.
28. Toso C, Trotter J, Wei A, Bigam DL, Shah S, Lancaster J, et al. Total tumor volume predicts risk of recurrence following liver transplantation in patients with hepatocellular carcinoma. Liver Transpl 2008; 14: 1107-15.
29. Mazzaferro V, Llovet JM, Miceli R, Bhoori S, Schiavo M, Mariani L, et al. Predicting survival after liver transplantation in patients with hepatocellular carcinoma beyond the Milan criteria: A retrospective, exploratory analysis. Lancet Oncol 2009; 10: 35-43.
30. Clavien PA, Lesurtel M, Bossuyt PM, Gores GJ, Langer B, Perrier A. Recommendations for liver transplantation for hepatocellular carcinoma: An international consensus conference report. Lancet Oncol 2012; 13: E11-22.
31. Volk ML, Vijan S, Marrero JA. A novel model measuring the harm of transplanting hepatocellular carcinoma exceeding Milan criteria. Am J Transplant 2008; 8: 839-46.
32. Vitale A, Volk ML, Gambato M, Zanus G, D'Amico F, Carraro A, et al. Estimation of the harm to the waiting list as a crucial factor in the selection of patients with hepatocellular carcinoma for liver transplantation. Transplant Proc 2010; 42: 1194-6.
33. Broelsch CE, Frilling A, Malago M. Should we expand the criteria for liver transplantation for hepatocellular carcinomaeyes, of course! J Hepatol 2005; 43: 569-73.
34. Vester U, Schaefer A, Kranz B, Wingen AM, Nadalin S, Paul A, et al. Development of growth and body mass index after pediatric renal transplantation. Pediatr Transplant 2005; 9: 445-9.
35. Freeman RB, Edwards EB, Harper AM.Waiting list removal rates among patients with chronic and malignant liver diseases. Am J Transplant 2006; 6: 1416-21.
36. Massie AB, Caffo B, Gentry SE, Hall EC, Axelrod DA, Lentine KL, et al. MELD exceptions and rates of waiting list outcomes. Am J Transplant 2011; 11: 2362-71.
37. Neuberger J. Liver allocation for patients with hepatocellular carcinoma. Liver Transpl 2010; 16: 249-51.
38. Toso C, Mentha G, Kneteman NM, Majno P. The place of downstaging for hepatocellular carcinoma. J Hepatol 2010; 52: 930-6.
39. Mazzaferro V, Battiston C, Perrone S, Pulvirenti A, Regalia E, Romito R, et al. Radiofrequency ablation of small hepatocellular carcinoma in cirrhotic patients awaiting liver transplantation: A prospective study. Ann Surg 2004; 240: 900-9.
40. Fontana RJ, Hamidullah H, Nghiem H, Greenson JK, Hussain H, Marrero J, et al. Percutaneous radiofrequency thermal ablation of hepatocellular carcinoma: A safe and effective bridge to liver transplantation. Liver Transpl 2002; 8: 1165-74.
41. Bharat A, Brown DB, Crippin JS, Gould JE, Lowell JA, Shenoy S, et al. Pre-liver transplantation locoregional adjuvant therapy for hepatocellular carcinoma as a strategy to improve longterm survival. J Am Coll Surg 2006; 203: 411-20.
42. Yao FY, Kinkhabwala M, LaBerge JM, Bass NM, Brown Jr. R, Kerlan R, et al. The impact of pre-operative loco-regional therapy on outcome after liver transplantation for hepatocellular carcinoma. Am J Transplant 2005; 5: 795-804.
43. Yao FY, Kerlan Jr. RK, Hirose R, Davern 3rd TJ, Bass NM, Feng S, et al. Excellent outcome following down-staging of hepatocellular carcinoma prior to liver transplantation: An intention-to-treat analysis. Hepatology 2008; 48: 819-27.
44. Ravaioli M, Grazi GL, Piscaglia F, Trevisani F, Cescon M, Ercolani G, et al. Liver transplantation for hepatocellular carcinoma: Results of down-staging in patients initially outside the Milan selection criteria. Am J Transplant 2008; 8: 2547-57.
45. Cillo U, Vitale A, Grigoletto F, Gringeri E, D'Amico F, Valmasoni M, et al. Intention-to-treat analysis of liver transplantation in selected, aggressively treated HCC patients exceeding the Milan criteria. Am J Transplant 2007; 7: 972-81.
46. Duffy JP, Vardanian A, Benjamin E, Watson M, Farmer DG, Ghobrial RM, et al. Liver transplantation criteria for hepatocellular carcinoma should be expanded: A 22-year experience with 467 patients at UCLA. Ann Surg 2007; 246: 502-9.
47. Chapman WC, Majella Doyle MB, Stuart JE, Vachharajani N, Crippin JS, Anderson CD, et al. Outcomes of neoadjuvant transarterial chemoembolization to downstage hepatocellular carcinoma before liver transplantation. Ann Surg 2008; 248: 617-25.
48. Majno PE, Adam R, Bismuth H, Castaing D, Ariche A, Krissat J, et al. Influence of preoperative transarterial lipiodol chemoembolization on resection and transplantation for hepatocellular carcinoma in patients with cirrhosis. Ann Surg 1997; 226: 688-701.
49. Decaens T, Roudot-Thoraval F, Bresson-Hadni S, Meyer C, Gugenheim J, Durand F, et al. Impact of pretransplantation transarterial chemoembolization on survival and recurrence after liver transplantation for hepatocellular carcinoma. Liver Transpl 2005; 11: 767-75.
50. Roayaie S, Frischer JS, Emre SH, Fishbein TM, Sheiner PA, Sung M, et al. Long-term results with multimodal adjuvant therapy and liver transplantation for the treatment of hepatocellular carcinomas larger than 5 centimeters. Ann Surg 2002; 235: 533-9.
51. Graziadei IW, Sandmueller H, Waldenberger P, Koenigsrainer A, Nachbaur K, Jaschke W, et al. Chemoembolization followed by liver transplantation for hepatocellular carcinoma impedes tumor progression while on the waiting list and leads to excellent outcome. Liver Transpl 2003; 9: 557-63.
52. Yang SH, Suh KS, Lee HW, Cho EH, Cho JY, Cho YB, et al. A revised scoring system utilizing serum alphafetoprotein levels to expand candidates for living donor transplantation in hepatocellular carcinoma. Surgery 2007; 141: 598-609.
53. Lesurtel M, Mullhaupt B, Pestalozzi BC, Pfammatter T, Clavien PA. Transarterial chemoembolization as a bridge to liver transplantation for hepatocellular carcinoma: An evidence-based analysis. Am J Transplant 2006; 6: 2644-50.
54. Sala M, Fuster J, Llovet JM, Navasa M, Sole M, Varela M, et al. High pathological risk of recurrence after surgical resection for hepatocellular carcinoma: An indication for salvage liver transplantation. Liver Transpl 2004; 10: 1294-300.
55. Cherqui D, Laurent A, Mocellin N, Tayar C, Luciani A, Van Nhieu JT, et al. Liver resection for transplantable hepatocellular carcinoma: Long-term survival and role of secondary liver transplantation. Ann Surg 2009; 250: 738-46.
56. Fuks D, Dokmak S, Paradis V, Diouf M, Durand F, Belghiti J. Benefit of initial resection of hepatocellular carcinoma followed by transplantation in case of recurrence: An intention-to-treat analysis. Hepatology 2012; 55: 132-40.
57. Landman MP, Feurer ID, Pinson CW, Moore DE. Which is more cost-effective under the MELD system: Primary liver transplantation, or salvage transplantation after hepatic resection or after loco-regional therapy for hepatocellular carcinoma within Milan criteria? HPB Oxf 2011; 13: 783-91.
58. Giannini EG, Cucchetti A, Vitale A. Prognostic prediction and identification of candidates to salvage liver transplantation in patients with early hepatocellular carcinoma. Liver Transpl 2014; 20: 1150-1.
59. Kulik L, Abecassis M. Living donor liver transplantation for hepatocellular carcinoma. Gastroenterology 2004; 127: S277-82.
60. Freeman Jr. RB, Wiesner RH, Harper A, McDiarmid SV, Lake J, Edwards E, et al. The new liver allocation system: Moving toward evidence-based transplantation policy. Liver Transpl 2002; 8: 851-8.
61. Bruix J, Gores GJ, Mazzaferro V. Hepatocellular carcinoma: Clinical frontiers and perspectives. Gut 2014; 63: 844-55.
62. Toso C, Mazzaferro V, Bruix J, Mentha G, Majno P. Towards a better liver graft allocation between candidates with and without hepatocellular carcinoma. Am J Transplant 2014. http://dx.doi.org/10.1111/ajt.12923 [in press].
63. Vitale A, Morales RR, Zanus G, Farinati F, Burra P, Angeli P, et al. Barcelona Clinic Liver Cancer staging and transplant survival benefit for patients with hepatocellular carcinoma: A multicentre, cohort study. Lancet Oncol 2011; 12: 654-62.
64. Piscaglia F, Camaggi V, Ravaioli M, Grazi GL, Zanello M, Leoni S, et al. A new priority policy for patients with hepatocellular carcinoma awaiting liver transplantation within the model for end-stage liver disease system. Liver Transpl 2007; 13: 857-66.
65. Toso C, Dupuis-Lozeron E, Majno P, Berney T, Kneteman NM, Perneger T, et al. A model for dropout assessment of candidates with or without hepatocellular carcinoma on a common liver transplant waiting list. Hepatology 2012; 56: 149-56.
66. Ravaioli M, Grazi GL, Dazzi A, Bertuzzo V, Ercolani G, Cescon M, et al. Survival benefit after liver transplantation: A single European center experience. Transplantation 2009; 88: 826-34.
67. Schaubel DE, Guidinger MK, Biggins SW, Kalbfleisch JD, Pomfret EA, Sharma P, et al. Survival benefit-based deceaseddonor liver allocation. Am J Transplant 2009; 9: 970-81.
68. Merion RM, Schaubel DE, Dykstra DM, Freeman RB, Port FK, Wolfe RA. The survival benefit of liver transplantation. Am J Transplant 2005; 5: 307-13.
69. Northup PG, Intagliata NM, Shah NL, Pelletier SJ, Berg CL, Argo CK. Excess mortality on the liver transplant waiting list: Unintended policy consequences and MELD Inflation. Hepatology 2014. http://dx.doi.org/10.1002/hep.27283 [in press].
70. Wiesner RH, Fung JJ. Present state of immunosuppressive therapy in liver transplant recipients. Liver Transpl 2011; 17: S1-9.
71. Beckebaum S, Cicinnati VR, Radtke A, Kabar I. Calcineurin inhibitors in liver transplantation - still champions or threatened by serious competitors? Liver Int 2013; 33: 656-65.
72. http://srtr.transplant.hrsa.gov/annual-reports/2011/. [accessed 08.07.14].
73. Cai J, Terasaki PI. Induction immunosuppression improves long-term graft and patient outcome in organ transplantation: An analysis of United Network for Organ Sharing registry data. Transplantation 2010; 90: 1511-5.
74. Ojo AO, Held PJ, Port FK,Wolfe RA, Leichtman AB, Young EW, et al. Chronic renal failure after transplantation of a nonrenal organ. N Engl J Med 2003; 349: 931-40.
75. Vivarelli M, Cucchetti A, Piscaglia F, La Barba G, Bolondi L, Cavallari A, et al. Analysis of risk factors for tumor recurrence after liver transplantation for hepatocellular carcinoma: Key role of immunosuppression. Liver Transpl 2005; 11: 497-503.
76. Hojo K, Hiramine C. In vivo effects of cyclosporin A: Abrogation of the induction of experimental allergic orchitis and sparing of the generation of suppressor cells. Int Arch Allergy Appl Immunol 1985; 78: 63-70.
77. Herman M, Weinstein T, Korzets A, Chagnac A, Ori Y, Zevin D, et al. Effect of cyclosporin A on DNA repair and cancer incidence in kidney transplant recipients. J Lab Clin Med 2001; 137: 14-20.
78. Martinez-Llordella M, Puig-Pey I, Orlando G, Ramoni M, Tisone G, Rimola A, et al. Multiparameter immune profiling of operational tolerance in liver transplantation. Am J Transplant 2007; 7: 309-19.
79. Orlando G, Baiocchi L, Cardillo A, Iaria G, De Liguori Carino N, De Luca L, et al. Switch to 1.5 grams MMF monotherapy for CNI-related toxicity in liver transplantation is safe and improves renal function, dyslipidemia, and hypertension. Liver Transpl 2007; 13: 46-54.
80. Hui IC, Tung EK, Sze KM, Ching YP, Ng IO. Rapamycin and CCI-779 inhibit the mammalian target of rapamycin signalling in hepatocellular carcinoma. Liver Int 2010; 30: 65-75.
81. Sahin F, Kannangai R, Adegbola O, Wang J, Su G, Torbenson M. mTOR and P70 S6 kinase expression in primary liver neoplasms. Clin Cancer Res 2004; 10: 8421-5.
82. Semela D, Piguet AC, Kolev M, Schmitter K, Hlushchuk R, Djonov V, et al. Vascular remodeling and antitumoral effects of mTOR inhibition in a rat model of hepatocellular carcinoma. J Hepatol 2007; 46: 840-8.
83. Toso C, Meeberg GA, Bigam DL, Oberholzer J, Shapiro AM, Gutfreund K, et al. De novo sirolimus-based immunosuppression after liver transplantation for hepatocellular carcinoma: Long-term outcomes and side effects. Transplantation 2007; 83: 1162-8.
84. Cholongitas E, Mamou C, Rodriguez-Castro KI, Burra P. Mammalian target of rapamycin inhibitors are associated with lower rates of hepatocellular carcinoma recurrence after liver transplantation: A systematic review. Transpl Int 2014. http://dx.doi.org/10.1111/tri.12372 [in press].
85. Schnitzbauer AA, Zuelke C, Graeb C, Rochon J, Bilbao I, Burra P, et al. A prospective randomised, open-labeled, trial comparing sirolimus-containing versus mTOR-inhibitor-free immunosuppression in patients undergoing liver transplantation for hepatocellular carcinoma. BMC Cancer 2010; 10: 190.
86. Roayaie S, Schwartz JD, Sung MW, Emre SH, Miller CM, Gondolesi GE, et al. Recurrence of hepatocellular carcinoma after liver transplant: Patterns and prognosis. Liver Transpl 2004; 10: 534-40.
87. Regalia E, Fassati LR, Valente U, Pulvirenti A, Damilano I, Dardano G, et al. Pattern and management of recurrent hepatocellular carcinoma after liver transplantation. J Hepatobiliary Pancreat Surg 1998; 5: 29-34.
88. Davis E, Wiesner R, Valdecasas J, Kita Y, Rossi M, Schwartz M. Treatment of recurrent hepatocellular carcinoma after liver transplantation. Liver Transpl 2011; 17: S162-6.
89. Samoylova ML, Dodge JL, Yao FY, Roberts JP. Time to transplantation as a predictor of hepatocellular carcinoma recurrence after liver transplantation. Liver Transpl 2014; 20: 937-44.
90. Welker MW, Bechstein WO, Zeuzem S, Trojan J. Recurrent hepatocellular carcinoma after liver transplantation-an emerging clinical challenge. Transpl Int 2013; 26: 109-18.
91. Llovet JM, Ricci S, Mazzaferro V, Hilgard P, Gane E, Blanc JF, et al. Sorafenib in advanced hepatocellular carcinoma. N Engl J Med 2008; 359: 378-90.
92. Cheng AL, Kang YK, Chen Z, Tsao CJ, Qin S, Kim JS, et al. Efficacy and safety of sorafenib in patients in the Asia-Pacific region with advanced hepatocellular carcinoma: A phase III randomised, double-blind, placebo-controlled trial. Lancet Oncol 2009; 10: 25-34.
93. Sposito C, Mariani L, Germini A, Flores Reyes M, Bongini M, Grossi G, et al. Comparative efficacy of sorafenib versus best supportive care in recurrent hepatocellular carcinoma after liver transplantation: A case-control study. J Hepatol 2013; 59: 59-66.
94. Weinmann A, Niederle IM, Koch S, Hoppe-Lotichius M, Heise M, Duber C, et al. Sorafenib for recurrence of hepatocellular carcinoma after liver transplantation. Dig Liver Dis 2012; 44: 432-7.
95. Gomez-Martin C, Bustamante J, Castroagudin JF, Salcedo M, Garralda E, Testillano M, et al. Efficacy and safety of sorafenib in combination with mammalian target of rapamycin inhibitors for recurrent hepatocellular carcinoma after liver transplantation. Liver Transpl 2012; 18: 45-52.
96. Vitale A, Boccagni P, Kertusha X, Zanus G, D'Amico F, Lodo E, et al. Sorafenib for the treatment of recurrent hepatocellular carcinoma after liver transplantation? Transplant Proc 2012; 44: 1989-91.