| Liver transplantation has emerged as a vital therapeutic option for patients with liver cancer such as hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC). Liver transplantation is known to offer a curative treatment for select patients with HCC, not amenable to resection. The utilization of expanded criteria for selecting candidates and incorporating locoregional therapies to bridge to transplant has significantly improved survival rates. CC presents unique challenges due to its aggressive nature and limited treatment options. Liver transplantation has demonstrated promising outcomes in carefully selected patients with early-stage hilar CC, where traditional surgical approaches are not feasible, but neoadjuvant chemoradiation therapy is tolerable. In addition, there is accumulating evidence of the efficacy of treating intrahepatic CC by liver transplantation from very early disease to advanced disease. However, the shortage of suitable donor organs remains a critical constraint, necessitating careful patient selection determined by various scoring systems and new technologies to expand the donor pool. Colorectal cancer liver metastasis (CRLM) was considered a contraindication for liver transplantation but is now evolving to be the last resort for highly selected cases. Advancements in neoadjuvant chemotherapy and aggressive liver-directed treatment have expanded the pool of eligible patients for transplantation, leading to improved outcomes. To address the critical need for reliable post-transplant monitoring for these malignancies, emerging technologies like circulating tumor DNA and liquid biopsy hold great promise. These non-invasive tools enable early detection of tumor recurrence and potentially allow for the assessment of treatment response, aiding in timely intervention with improved patient outcomes. Incorporating these advanced technologies into post-transplant surveillance protocols may provide valuable insights into personalized treatment strategies to enhance long-term patient survival. Taken together, this presentation will highlight patient care with liver transplantation for these malignancies based on the most recent reports worldwide and my personal experience at Cleveland Clinic. |
