Clinical Practice Guidelines for Liver Transplantation for Liver Cancer in China

     Liver transplantation is recognized worldwide as one of the effective treatments for end-stage liver disease. At present, liver transplantation has been widely carried out nationwide, and there is an urgent need for relevant clinical practice guidelines to guide the national liver transplantation work in a more standardized, effective and safe manner. The Chinese Society of Organ Transplantation, the Transplantation Group of the Chinese Society of Surgery and the Organ Transplantation Physicians Branch of the Chinese Medical Association have organized experts to develop the Clinical Practice Guidelines for Liver Transplantation for Liver Cancer in China (2014 Edition), which focuses on five parts: liver transplantation recipient selection criteria, preoperative descending therapy, recipient antiviral therapy, recipient immunosuppressive application, and prevention and treatment of tumor recurrence after surgery. The Milan criteria are the reference benchmark for liver cancer liver transplant recipient selection, while the Hangzhou criteria are a great breakthrough from the Milan criteria limited to tumor morphology.  Preoperative tumor downstaging treatment for liver cancer liver transplantation can enable patients who do not meet the liver cancer liver transplant recipient selection criteria to be included in the transplantation criteria and be offered liver transplantation opportunities. Antiviral therapy for liver cancer liver transplant recipients with viral hepatitis B can help reduce the recurrence rate of viral hepatitis B after transplantation and improve the long-term survival rate of recipients. Individualized low-dose immunosuppressive regimens are currently advocated to maximize the protection of transplanted liver function while reducing its toxic side effects and recurrence of liver cancer after transplantation. The prevention and treatment of liver cancer recurrence after liver transplantation can be individualized for the recipient by using surgery, TACE, local ablation, as well as radioimmunotherapy, targeted therapy, and systemic chemotherapy.