APASL 2020| Prof.Toar J. M Lalisang:Liver Transplantation for Small HCC: Where Do We Stand?

The detection rate of small liver cancer patients is increasing gradually, and its treatment methods are various.Liver transplantation is the most effective method for the treatment of liver cancer. How to select the patients receiving liver transplantation?The 29th annual meeting of the Asia Pacific Society of Liver Diseases (APASL2020) invited Professor J. M. Lalisang from Cipto Mangunkusumo General Hospital in Indonesia to conduct "Liver Transplantation for Small HCC: Where Do We Stand?"State of The Art Lecture theme report.During the meeting, Professor Lalisang also answered questions from hepatology Digest, as detailed below.

<Hepatology Digest>: The incidence of small liver cancer is increasing and the treatments are various. How do you select patients for cancer transplantation?

 

Dr. Lalisang: As mentioned like in my doc, my slide, first now we must include the tumor behavior. We are not anymore directly only thinking about the number and the size. But now, the criteria must be for to decide liver function or not. It’s more important the behavior of the tumor. So, you must put like differentiation and the markers of the tumor. Like IFP, good differentiation. So, if it is small and the Child-Pugh liver condition is an A, so first I will choose liver resection, not the liver transplant. Especially why I say it like this is because in Indonesia, the donor is—not enough donors I know—but the cadaveric donor is not working right now. But if I find a living donor, what do I call, it is not ready. So, if and when we have already, we can choose the donor, but you know, to prepare a donor it just takes time. So, usually, this does not justify it in a small one when resection can be done, better resection can be done. As long as the liver condition is good and the remnant liver will be still enough. But then if in small tumor, I think if the Child-Pugh is more than B or C.  So that is because small we are not talking about the remnant liver because this will still be enough. But we are thinking more about the liver condition. But the important thing is also because we are using a living donor, it is a little bit different. Because we must be fair for the donor. If we are facing a very high recurrence, a very aggressive tumor—it is aggressive like a fairly high IFP—I think it does not also justify it even though the donor can give the liver. I think it is not what we call fair because very high recurrence will be happening.

<Hepatolgoy Digest>: What are the main risk factors for recurrence after liver transplantation? 

Dr. Lalisang: Yeah, they are still in the study. But before we already know if you have an underlying disease like B or C where it is not controllable before, they—hep B and C—impact to make the HCC, I think we are faced with a very high recurrency. The second is the behavior. We don’t know if it is a very poorly differentiated HCC or a very large one. And there are, what do you call it, in the margin they’re already infection to the vascular system. I think it is also very—I suspect it to be—a very high recurrency. Operative technique is also very important, how long is the ischemic cold, and warm ischemic, it is also in how much bleeding you get. So technically, I think you are asking the last question like this. First, you must have a very good surgery technique and also the law for to how to manage cancer—liver cancer tumor—must be followed, like not touched anymore, no manipulation too hard. And also, the condition. And while I think the prevention is to control the underlying disease: hep B or the hep C. 

Dr. Lalisang, who has a close friendship with Chinese liver surgeons, expressed his hope and best wishes to Chinese medical workers to overcome the virus as soon as possible.

“I learn liver transplant first I go to Hangzhou, and then another connection with Prof.XiaoPing Chen . And there’s many friends also in Taiwan, also in Hong Kong. Hopefully they will overcome the corona virus as soon as possible.”