Evidence map›Paper›PMID 41635909›Full record

ArticleJHEP reports : innovation in hepatology2026

Liver transplantation for HCC with macrovascular invasion: A systematic review and meta-analysis of observational studies.

Farah Ladak, Christian Tibor Josef Magyar, Felipe D Gaviria, Woo Jin Choi, Anudari Zorigtbaatar, Roxana Bucur, Nadia Rukavina, Arndt Vogel, Grainne Mary O'Kane, Zhihao Li and 2 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in JHEP reports : innovation in hepatology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Farah LadakHBP & Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada.
Christian Tibor Josef MagyarHBP & Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada.
Felipe D GaviriaHBP & Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada.
Woo Jin ChoiHBP & Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada.
Anudari ZorigtbaatarHBP & Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada.
Roxana BucurHBP & Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada.
Nadia RukavinaHBP & Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada.
Arndt VogelDivision of Gastroenterology and Hepatology, Toronto General Hospital, Toronto, ON, Canada.
Grainne Mary O'KanePrincess Margaret Cancer Center, University Health Network, Toronto, ON, Canada.
Zhihao LiHBP & Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada.
Marina EnglesakisHBP & Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada.
Gonzalo SapisochinHBP & Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background & Aims: Traditional guidelines discourage liver transplantation (LT) in patients with hepatocellular carcinoma (HCC) with macrovascular invasion (MVI). However, emerging evidence suggests that long-term survival is possible when LT is preceded by downstaging therapies. Thus, a pooled analysis of time-dependent risk factor effect size on overall survival (OS) is warranted to determine the effect size of MVI, estimate risk mitigation through downstaging, and design future trials. Methods: MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, and the Cochrane Register were systematically searched from their inception to 24 January 2023. Studies with comparative oncological outcome data between patients with HCC and MVI (MVI group) and HCC patients without MVI (non-MVI group) were included. Frequentist pairwise meta-analysis (random-effects model) was performed for primary outcomes of OS and recurrence-free survival (RFS) at 5 years. Only studies with adjusted effect estimates were considered for analysis. Results: In total, 10 studies were included in this systematic review and meta-analysis, contributing 15,899 patients. Seven studies included deceased donor LT, and four studies included living donor LT. In the quantitative analysis of studies reporting adjusted effect estimates, presence of MVI was associated with lower 5-year OS (hazard ratio (HR) 2.03; 95% CI 1.60-2.57; Conclusions: Effective downstaging in carefully selected patients with HCC with MVI could achieve survival outcomes approaching those of patients without MVI. Further studies are essential to validate these findings and to clarify which downstaging approaches and tumor characteristics are most likely to confer a transplant benefit. Impact and implications: This meta-analysis provides the first pooled HRs for the effect of MVI on LT outcomes, emphasizing the potential for downstaging therapies to mitigate poor prognosis in HCC. The findings advocate for redefining LT eligibility criteria to incorporate successful downstaging protocols, potentially expanding treatment options for advanced HCC. These insights underline the need for standardized downstaging protocols and prospective trials to optimize patient selection and outcomes globally for LT.

Indexed as

DownstagingExpanded criteriaHepatocellular carcinomaLiver transplantPortal vein tumor thrombus

Identifiers

PMID41635909
PMCPMC12862345

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.