Decisão clínica no transplante hepático por hepatocarcinoma: um estudo de factores de prognóstico clínicos e moleculares

ABSTRACT: HCC (hepatocellular carcinoma) is a highly prevalent disease and the second leading cause of cancer-related mortality in the world. Liver transplantation (LT) is currently the best treatment for HCC in cirrhotic patients, even in the case of advanced liver-only disease; nonetheless it carries the problem of organ availability and competition from patients more capable of benefiting from this kind of therapy. New approaches to deal with organ shortage need to be explored. On the other hand, proper selection of patients is . Current clinical morphological models, namely the Milan Criteria, may exclude excellent candidates. Furthermore, patients with early HCC and an aggressive biological behavior are not excluded by current criteria. It is imperative that better selection models are developed, which are more sensitive and specific. Molecular markers can predict the behavior and aggressiveness of HCC. Consequently, it is likely that integrating clinical and molecular features will be the basis of improved decision criteria, achieving a better patient selection for LT due to HCC in the setting of cirrhosis. The main objective of this work was to identify, in cirrhotic patients with HCC, the best candidates for liver transplantation.Specifically, we analyzed the impact of domino liver transplantation in this setting as a means to ameliorate the problem of organ availability. We refined clinical criteria for selection of cirrhotic HCC patients for LT. We further evaluated molecular biomarkers of prognosis in HCC as putative biomarkers for LT success. Ultimately, we aimed to integrate clinical and molecular data in order to launch the basis for improved decision criteria, which after a prospective validation could be applied in a larger population