Nuevo Usuario

Recordar Contraseña

Revisiones en Cáncer 00112 / http://dx.doi.org/10.20960/revcancer.00112

Resumen| PDF

Revisión

Carcinoma hepatocelular y trasplante hepático

Marina Berenguer

Prepublicado: 2025-06-11

Publicado: 2025-09-11

VOLUMEN 39, NÚM. 2, marzo-abril (2025), PAG. 55-105

Logo Descargas Número de descargas: 11661 Logo Visitas Número de visitas: 523 Citas Citas: 0

Compártelo:

El hepatocarcinoma (HCC) representa una de las principales causas de mortalidad por cáncer en el mundo y constituye una indicación ampliamente aceptada de trasplante hepático (TH). Este artículo revisa de forma exhaustiva la epidemiología actual del TH por HCC, analizando las tendencias temporales. Se detallan las indicaciones aceptadas y expandidas, incluyendo los principales modelos de selección como los criterios de Milán, UCSF, Up-to-Seven, Metroticket 2.0 y NYCA. Asimismo, se describen las estrategias de “bridging” y “downstaging”, incorporando terapias locorregionales e inmunoterapia en el contexto pretrasplante. Se analiza en profundidad la predicción de recurrencia post-TH, presentando una tabla comparativa de los modelos disponibles y discutiendo el papel emergente del ctDNA (ADN tumoral circulante). Finalmente, se propone un protocolo de vigilancia estratificado basado en el riesgo de recurrencia, subrayando la importancia de un enfoque personalizado en el seguimiento postrasplante.

Palabras Clave: Trasplante hepático. Hepatocarcinoma. Downstaging. Inmunoterapia. Criterios de Milán. Metroticket.

Descargar PDF

Bibliografía
Artículos Relacionados

Forner A, Reig M, Bruix J. Hepatocellular carcinoma. Lancet 2018;391(10127):1301-14.
DOI: 10.1016/S0140-6736(18)30010-2

Kulik L, El-Serag HB. Epidemiology and Management of Hepatocellular Carcinoma. Gastroenterology 2019;156(2):477-91.
DOI: 10.1053/j.gastro.2018.08.065

Brown ZJ, Tsilimigras DI, Ruff SM, Mohseni A, Kamel IR, Cloyd JM, et al. Management of Hepatocellular Carcinoma: A Review. JAMA Surg 2023;158(4):410-20.
DOI: 10.1001/jamasurg.2022.7989

Mehta N, Bhangui P, Yao FY, Mazzaferro V, Toso C, Akamatsu N, et al. Liver Transplantation for Hepatocellular Carcinoma. Working Group Report from the ILTS Transplant Oncology Consensus Conference. Transplantation 2020;104(6):1136-42.
DOI: 10.1097/TP.0000000000003174

Berenguer M, Burra P, Ghobrial M, Hibi T, Metselaar H, Sapisochin G, et al. Posttransplant Management of Recipients Undergoing Liver Transplantation for Hepatocellular Carcinoma. Working Group Report from the ILTS Transplant Oncology Consensus Conference. Transplantation 2020;104(6):1143-9.
DOI: 10.1097/TP.0000000000003196

Claasen MPAW, Sneiders D, Rakké YS, Adam R, Bhoori S, Cillo U, et al. European Society of Organ Transplantation (ESOT) Consensus Report on Downstaging, Bridging and immunotherapy in Liver Transplantation for Hepatocellular Carcinoma. Transpl Int 2023;36:11648.
DOI: 10.3389/ti.2023.11648

European Association for the Study of the Liver. EASL Clinical Practice Guidelines on the management of hepatocellular carcinoma. J Hepatol 2025;82(2):315-74.

Kodali S, Kulik L, D’Allessio A, De Martin E, Hakeem AR, Lewinska M, et al. The 2024 ILTS-ILCA consensus recommendations for liver transplantation for hepatocellular carcinoma and intrahepatic cholangiocarcinoma. Liver Transpl 2025;31(6):815-31.

Berenguer M, Agarwal K, Burra P, Manns M, Samuel D. The road map toward an hepatitis C virus-free transplant population. Am J Transplant 2018;18(10):2409-16.
DOI: 10.1111/ajt.14976

Berenguer M, de la Rosa Rodríguez G, Domínguez-Gil B. Significant impact of new oral therapies against HCV on the waiting list for liver transplantation in Spain. J Hepatol 2018;69(4):966-8.
DOI: 10.1016/j.jhep.2018.06.011

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(11):693-9.
DOI: 10.1056/NEJM199603143341104

El-Serag HB. Hepatocellular carcinoma. N Engl J Med 2011;365(12):1118-27.
DOI: 10.1056/NEJMra1001683

Ince V, Sahin TT, Akbulut S, Yilmaz S. Liver transplantation for hepatocellular carcinoma: Historical evolution of transplantation criteria. World J Clin Cases. 2022;10(29):10413-27.
DOI: 10.12998/wjcc.v10.i29.10413

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.
DOI: 10.1002/lt.21484

Mazzaferro V, Llovet JM, Miceli R, Bhoori S, Schiavo M, Mariani L, et al.; Metroticket Investigator Study Group. Predicting survival after liver transplantation in patients with hepatocellular carcinoma beyond the Milan criteria: a retrospective, exploratory analysis. Lancet Oncol 2009;10(1):35-43.
DOI: 10.1016/S1470-2045(08)70284-5

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(6):1394-403.
DOI: 10.1053/jhep.2001.24563

Duvoux C, Roudot-Thoraval F, Decaens T, et al. Liver transplantation for hepatocellular carcinoma: a model including α-fetoprotein improves the performance of Milan criteria. Hepatology 2012;56(6):1988-96.

Duvoux C, Decaens T, Pessione F, et al. Prospective validation of the AFP model in liver transplantation for hepatocellular carcinoma: A French multicenter experience. Hepatology 2016;63(3):915-22.

Mazzaferro V, Sposito C, Zhou J, Pinna AD, De Carlis L, Fan J, et al. Metroticket 2.0 Model for Analysis of Competing Risks of Death After Liver Transplantation for Hepatocellular Carcinoma. Gastroenterology 2018;154(1):128-39.
DOI: 10.1053/j.gastro.2017.09.025

Cucchetti A, Serenari M, Sposito C, Di Sandro S, Mosconi C, Vicentin I, et al. Including mRECIST in the Metroticket 2.0 criteria improves prediction of hepatocellular carcinoma-related death after liver transplant. J Hepatol 2020;73(2):342-8.
DOI: 10.1016/j.jhep.2020.03.018

Halazun KJ, Tabrizian P, Najjar M, Florman S, Schwartz M, Michelassi F, et al. Is it Time to Abandon the Milan Criteria? Results of a Bicoastal US Collaboration to Redefine Hepatocellular Carcinoma Liver Transplantation Selection Policies. Ann Surg 2018;268(4):690-9.
DOI: 10.1097/SLA.0000000000002964

Halazun KJ, Rosenblatt RE, Mehta N, Lai Q, Doyle MB, Tabrizian P, et al. Dynamic α-Fetoprotein Response and Outcomes After Liver Transplant for Hepatocellular Carcinoma. JAMA Surg 2021;156(6):559-67.
DOI: 10.1001/jamasurg.2021.0954

Mazzaferro V, Citterio D, Bhoori S, Bongini M, Miceli R, De Carlis L, et al. Liver transplantation in hepatocellular carcinoma after tumour downstaging (XXL): a randomised, controlled, phase 2b/3 trial. Lancet Oncol 2020;21(7):947-56.
DOI: 10.1016/S1470-2045(20)30224-2

Murali AR, Romero-Marrero C, Miller C, Aucejo F, Levitin A, Gill A, et al. Predictors of Successful Downstaging of Hepatocellular Carcinoma Outside Milan Criteria. Transplantation 2016;100(11):2391-7.
DOI: 10.1097/TP.0000000000001402

Hameed B, Mehta N, Sapisochin G, Roberts JP, Yao FY. Alpha-fetoprotein level > 1000 ng/mL as an exclusion criterion for liver transplantation in patients with hepatocellular carcinoma meeting the Milan criteria. Liver Transpl 2014;20(8):945-51.
DOI: 10.1002/lt.23904

Mehta N, Dodge JL, Roberts JP, Hirose R, Yao FY. Alpha-Fetoprotein Decrease from > 1,000 to < 500 ng/mL in Patients with Hepatocellular Carcinoma Leads to Improved Posttransplant Outcomes. Hepatology 2019;69(3):1193-205.
DOI: 10.1002/hep.30413

Mehta N, Guy J, Frenette CT, Dodge JL, Osorio RW, Minteer WB, et al. Excellent Outcomes of Liver Transplantation Following Down-Staging of Hepatocellular Carcinoma to Within Milan Criteria: A Multicenter Study. Clin Gastroenterol Hepatol 2018;16(6):955-64.
DOI: 10.1016/j.cgh.2017.11.037

Mehta N, Dodge JL, Grab JD, Yao FY. National experience on down-staging of hepatocellular carcinoma before liver transplant: Influence of locoregional therapy modality and type of response on outcomes. Clin Gastroenterol Hepatol 2022;20(8):1849-58.e3.

Kornberg A, Witt U, Schernhammer M, Kornberg J, Friess H, Thrum K. Development of a novel predictive model for successful downstaging of hepatocellular carcinoma prior to liver transplantation. Liver Transpl 2021;27(12):1747-59.

Johnson PJ, Berhane S, Kagebayashi C, Satomura S, Teng M, Reeves HL, et al. Assessment of liver function in patients with hepatocellular carcinoma: a new evidence-based approach—the ALBI grade. J Clin Oncol 2015;33(6):550-8.
DOI: 10.1200/JCO.2014.57.9151

Hiraoka A, Kumada T, Tada T, Kariyama K, Tani J, Fukunishi S, et al. EZ-ALBI score: A simple model to estimate the ALBI grade in patients with hepatocellular carcinoma. J Gastroenterol Hepatol 2021;36(3):700-7.

Crocetti L, Bozzi E, Scalise P, Bargellini I, Lorenzoni G, Ghinolfi D, et al. Locoregional Treatments for Bridging and Downstaging HCC to Liver Transplantation. Cancers (Basel) 2021;13(21):5558.
DOI: 10.3390/cancers13215558

Mosenthal M, Adams W, Cotler S, Ding X, Borge M, Malamis A, et al. Locoregional Therapies for Hepatocellular Carcinoma prior to Liver Transplant: Comparative Pathologic Necrosis, Radiologic Response, and Recurrence. J Vasc Interv Radiol 2024;35(4):506-14.
DOI: 10.1016/j.jvir.2023.12.009

Di Martino M, Ferraro D, Pisaniello D, Arenga G, Falaschi F, Terrone A, et al. Bridging therapies for patients with hepatocellular carcinoma awaiting liver transplantation: A systematic review and meta-analysis on intention-to-treat outcomes. J Hepatobiliary Pancreat Sci 2023;30(4):429-38.
DOI: 10.1002/jhbp.1248

Magyar CTJ, O’Kane GM, Aceituno L, Li Z, Vogel A, Bruix J, et al. Liver Transplantation for Hepatocellular Carcinoma: An Expanding Cornerstone of Care in the Era of Immunotherapy. J Clin Oncol 2025;43(5):589-604.
DOI: 10.1200/JCO.24.00857

Tabrizian P, Abdelrahim M, Schwartz M. Immunotherapy and transplantation for hepatocellular carcinoma. J Hepatol 2024;80(5):822-5.
DOI: 10.1016/j.jhep.2024.01.011

Rezaee-Zavareh MS, Yeo YH, Wang T, Guo Z, Tabrizian P, Ward SC, et al. Impact of pre-transplant immune checkpoint inhibitor use on post-transplant outcomes in HCC: A systematic review and individual patient data meta-analysis. J Hepatol 2025;82(1):107-19.
DOI: 10.1016/j.jhep.2024.06.042

Di Maira T, Little EC, Berenguer M. Immunosuppression in liver transplant. Best Pract Res Clin Gastroenterol 2020;46-47:101681.
DOI: 10.1016/j.bpg.2020.101681

Todeschini L, Cristin L, Martinino A, Mattia A, Agnes S, Giovinazzo F. The Role of mTOR Inhibitors after Liver Transplantation for Hepatocellular Carcinoma. Curr Oncol 2023;30(6):5574-92.
DOI: 10.3390/curroncol30060421

Geissler EK, Schnitzbauer AA, Zülke C, Lamby PE, Proneth A, Duvoux C, et al. Sirolimus Use in Liver Transplant Recipients with Hepatocellular Carcinoma: A Randomized, Multicenter, Open-Label Phase 3 Trial. Transplantation 2016;100(1):116-25.
DOI: 10.1097/TP.0000000000000965

Tejedor M, Selzner N, Berenguer M. Are MELD and MELDNa Still Reliable Tools to Predict Mortality on the Liver Transplant Waiting List? Transplantation 2022;106(11):2122-36.
DOI: 10.1097/TP.0000000000004163

Norman JS, Mehta N, Kim WR, Liang JW, Biggins SW, Asrai SK, et al. Model of Urgency for Liver Transplantation in Hepatocellular Carcinoma: A Practical Model to Prioritize Patients With Hepatocellular Carcinoma on the Liver Transplant Waitlist. Gastroenterology 2025;168(4):784-94.
DOI: 10.1053/j.gastro.2024.11.015

Liu H, Zhang W, Di M, Lee H, Shi L, Wang X, et al. Survival benefit associated with liver transplantation for hepatocellular carcinoma based on tumor burden scores at listing. Hepatol Commun 2025;9(1):e0619.
DOI: 10.1097/HC9.0000000000000619

Mehta N, Heimbach J, Harnois DM, Sapisochin G, Dodge JL, Lee D, et al. Validation of a Risk Estimation of Tumor Recurrence After Transplant (RETREAT) Score for Hepatocellular Carcinoma Recurrence After Liver Transplant. JAMA Oncol 2017;3(4):493-500.
DOI: 10.1001/jamaoncol.2016.5116

Halazun KJ, Najjar M, Abdelmessih RM, Samstein B Griesemer AD, Guarrera JV, et al. Recurrence After Liver Transplantation for Hepatocellular Carcinoma: A New MORAL to the Story. Ann Surg 2017;266(6):1144-50.
DOI: 10.1097/SLA.0000000000001966

Reddy T, Esmail A, Chang JC, Ghobrial RM, Abdelrahim M. Utility of Cell-Free DNA Detection in Transplant Oncology. Cancers 2022;14;743.
DOI: 10.3390/cancers14030743

Berenguer M, de Martin E, Hessheimer AJ, Levitsky J, Maluf DG, Mas VR, et al. European Society for Organ Transplantation Consensus Statement on Biomarkers in Liver Transplantation. Transpl Int 2023;36:11358.
DOI: 10.3389/ti.2023.11358

Huang A, Guo D, Zhang X, Sun Y, Zhang X, Fu X, et al. Publication Only Application of Circulating Tumor DNA for Prediction and Surveillance of Tumor Recurrence after Liver Transplantation: A Pilot Study. J Clin Oncol 2022;40:e16149.
DOI: 10.1200/JCO.2022.40.16_suppl.e16149

de’Angelis N, Landi F, Carra MC, Azoulay D. Managements of recurrent hepatocellular carcinoma after liver transplantation: A systematic review. World J. Gastroenterol 2015;21:11185-98.

Lee DD, Sapisochin G, Mehta N, Gorgen A, Musto KR, Hajda H, et al. Surveillance for HCC after Liver Transplantation: Increased monitoring may yield aggressive treatment options and improved postrecurrence survival. Transplantation 2020;104:2105-12.
DOI: 10.1097/TP.0000000000003117

Revisión: Quimioterapia en cáncer de esófago

Publicado: 2022-07-26 / http://dx.doi.org/

Resumen | PDF

Revisión: Líneas de investigación en cáncer de esófago

Publicado: 2022-07-26 / http://dx.doi.org/

Resumen | PDF

Revisión: Epidemiología e historia natural del cáncer de hígado

Publicado: 2022-07-28 / http://dx.doi.org/

Resumen | PDF

Revisión: Radiología en hepatocarcinoma

Publicado: 2022-07-28 / http://dx.doi.org/

Resumen | PDF

Revisión: Medicina de precisión y el papel de la irradiación en hepatocarcinoma

Publicado: 2022-07-28 / http://dx.doi.org/

Resumen | PDF

Revisión: Inmunoterapia en hepatocarcinoma

Publicado: 2022-07-28 / http://dx.doi.org/

Resumen | PDF

Revisión: Trasplante hepático en carcinoma hepatocelular

Publicado: 2022-07-28 / http://dx.doi.org/

Resumen | PDF

Revisión: Tratamiento médico del cáncer de estómago recurrente y metastásico en primera línea

Publicado: 2022-07-28 / http://dx.doi.org/

Resumen | PDF