18FDG PET scanner as a selection criterion in liver transplantation for hepatocarcinoma

For years, Milan criteria have been the standard for selection criteria for liver transplantation (LT) of patients with hepatocellular carcinoma (HCC). Previous retrospective studies suggested that 18 FDG positron tomography (18FDG-PET) could be an effective tool to select HCC patients beyond Milan criteria for LT if their tumour is not FDG avid. A prospective national study evaluating the potential role of 18FDG-PET in LT for HCC was initiated by BeLIAC and financed by the National Cancer Foundation for the years 2019-2022. Complete results of this study with 2-year follow-up will be available by the end of 2024. In this report the authors aimed to present the preliminary results of this study in the CHU Liege LT centre.
Methods: This study is a prospective national study accepted by all Belgian transplant centres and BeLIAC. All patients signed an informed consent form. Between January 2019 and October 2022, 51 patients (43 males, mean age 63y) were transplanted with HCC, and 44 had PET CT before LT or neoadjuvant therapy. Amongst these 44 HCC patients with PET, 28 were Milan-in, 1 Milan-in after successful downstaging, and 13 were Milan-out (11 Milan-out Up-to-seven-in and 2 Milan-out up-to-seven-out) at time of listing. Two Milan-in patients were PET positive, and all others were PET negative.
Results: Three patients died during the follow-up, without recurrence. No patients developed recurrence at 1- and 2-year follow-up. Three patients developed recurrence between 2- and 3-year follow-up and all were Milan-in. Importantly, no Milan-out PET negative patients developed recurrence at October 2022 follow-up.
Conclusions: PET FDG could be an important tool to offer potential LT opportunity to HCC patients outside Milan criteria. A longer follow-up and complete Belgian data are important before drawing further conclusions on this important matter.