Liver transplantation after successful downstaging of a locally advanced hepatocellular carcinoma with systemic therapy

Introduction: Liver transplantation (LT) is potentially curative for patients with cirrhosis and hepatocellular carcinoma (HCC). However, this procedure is usually reserved for patients with early tumor stages or after successful downstaging with local regional therapies (LRT). In patients with locally advanced HCC current guidelines recommend locoregional and palliative systemic therapies for tumor stages Barcelona Clinic Liver Cancer (BCLC) B and C respectively.Case report: In this article we describe a 63 -year-old male patient with locally advanced hepatocellular carcinoma (BCLC C) and hepatitis C associated cirrhosis. Following systemic treatment with the immune checkpoint inhibitor atezolizumab and the anti-VEGF antibody bevacizumab significant downstaging to a tumor stage within the Milan criteria was achieved after which liver transplantation was successfully performed. Conclusion: As more effective systemic therapies become available, liver transplantation and potential curative treatment could become feasible for selected patients with locally advanced HCC.