This protocol covers the management of transplant-eligible patients with early-stage hepatocellular carcinoma meeting Milan criteria in the context of clinically significant portal hypertension or decompensated cirrhosis.
When early-stage HCC within Milan criteria occurs alongside decompensated cirrhosis and/or clinically significant portal hypertension, transplant eligibility is the central clinical question. This sub-population requires a specific treatment strategy informed by both the oncological and hepatic disease burden.
Liver transplantation is the primary treatment considered for eligible patients in this setting. Depending on clinical circumstances, interventions aimed at controlling tumor growth during the transplant waiting period may also be part of the approach.
DOI: 10.1097/HEP.0000000000000466
Liver transplantation should be the treatment of choice for transplant-eligible patients with early-stage HCC occurring in the setting of clinically significant portal hypertension and/or decompensated cirrhosis (Level 2, Strong Recommendation).
AASLD advises the use of pre-transplant locoregional bridging therapy for patients being evaluated or listed for liver transplantation, if they have adequate hepatic reserve, to reduce the risk of waitlist dropout in the context of anticipated prolonged wait times for transplant (Level 3, Strong Recommendation).
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