Chapter 24 - Patient characteristics and evaluations prior to liver transplantation

Hepatocellular carcinoma (HCC) represents the most prevalent form of primary liver cancer. Liver transplantation (LT) is acknowledged as an innovative modality in the management of HCC, providing the opportunity to concurrently address both the neoplastic lesion and the associated underlying liver pathology. The complexities inherent in the surgical procedure, coupled with the primary goal of achieving optimal outcomes, emphasize the need for a meticulous evaluation process guided by specific criteria. This evaluation is imperative for selecting HCC patients who stand to derive maximal benefit from the transplantation procedure. Thus, several criteria and factors have been studied to identify the candidate's eligibility before transplantation. These considerations can be categorized into either liver-related or patient-related factors. In the context of liver-related factors, determining the primary tumor site before surgery has demonstrated a notable impact on LT outcomes. In contrast, the determination of the tumor stage did not exhibit a similar influence. Moreover, a thorough evaluation of infections and vaccination against preventable diseases is considered essential before transplantation. Additionally, the Model for End-Stage Liver Disease (MELD) score should be integrated with other considerations for optimal allocation. Concerning patient-related factors, considerations such as sex, obesity, psychiatric status, and tobacco consumption status have been identified as critical determinants in the evaluation of LT. In this chapter, we delineated the key considerations pivotal in evaluating an LT candidate, aiming to optimize outcomes.