The 2024 ILTS-ILCA consensus recommendations for liver transplantation for hepatocellular carcinoma and intrahepatic cholangiocarcinoma

Background: Liver transplantation (LT) provides the best long-term survival outcomes for patients with liver cancer. As a result, the field of transplant oncology has grown greatly over the past few decades, and many centers have expanded their criteria to allow increased access to LT for liver malignancies. Center-level guidelines and practices in transplant oncology significantly vary across the world, leading to debate regarding the best course of treatment for this patient population. Methods: An international consensus conference was convened by the International Liver Transplantation Society and the International Liver Cancer Association on February 1-2, 2024, in Valencia, Spain to establish a more universal consensus regarding LT for oncologic indications. The conference followed the Delphi process, followed by external expert review. Results: Consensus statements were accepted regarding patient assessment and waitlisting criteria, pre-transplant treatment (including immunotherapy) and downstaging, living donor liver transplantation, post-LT patient management, and patient-and caregiver-related outcomes. Conclusion: The multidisciplinary participants in the consensus conference provided up-to-date recommendations regarding the selection and management of patients with liver cancer being considered for LT. Although participants deferred to center protocols in many cases, there was great interest in safely expanding access to LT for patients with larger tumor burden and biologically amenable lesions.