Clinical practice guideline on liver transplantation for hepatocellular carcinoma in China (2021 edition)

The selection criteria for living-related donor LT in HCC candidates can be extended appropriately (Table 1).Table 1 Clinical practice guidelines on liver transplantation for hepatocellular carcinoma. V Strong Preoperative downstaging treatment of hepatocellular carcinoma for liver transplantation 9 Downstaging therapy includes TACE, yttrium-90 microsphere TARE, local ablation etc.; local ablation includes radiofrequency ablation, microwave ablation, cryoablation, and percutaneous ethanol injection. II Strong 11 The comprehensive evaluation index of downstaging efficacy should be based on tumor size and number, and changes in serum AFP and PIVKA-II levels II Strong 12 Downstaging or bridging treatment should be applied in a timely manner for LT candidates with an estimated waiting time >6 months II Strong 13 Hangzhou criteria can be used as the end point of preoperative downstaging treatment. The safe time interval between immunotherapy and LT remains controversial. [...]it should be noted that downstaging using immunotherapy might increase the risk of post-LT rejection, and post-LT surveillance should thus be increased and immunosuppressive therapy should also be intensified in these cases if necessary.