In this debate, the authors consider whether patients with hepatocellular carcinoma (HCC) and portal vein tumour thrombosis are candidates for liver transplantation (LT). The argument for LT in this context is based on the premise that, following successful downstaging treatment, LT confers a much greater clinical benefit in terms of survival outcomes than the available alternative (palliative systemic therapy). A major argument against relates to limitations in the quality of evidence for LT in this setting – in relation to study design, as well as heterogeneity in patient characteristics and downstaging protocols. While acknowledging the superior outcomes offered by LT for patients with portal vein tumour thrombosis, the counterargument is that expected survival in such patients is still below accepted thresholds for LT and, indeed, the levels achieved for other patients who receive transplants beyond the Milan criteria. Based on the available evidence, it seems too early for consensus guidelines to recommend such an approach, however, it is hoped that with higher quality evidence and standardised downstaging protocols, LT may soon be more widely indicated, including for this population with high unmet clinical need.

在这场争论中，作者考虑了肝细胞癌 (HCC) 和门静脉肿瘤血栓形成患者是否是肝移植（LT）的候选人。在这种情况下，LT 的论点基于以下前提：在成功的降期治疗后，LT 在生存结果方面比可用的替代方案（姑息性全身治疗）具有更大的临床益处。反对的主要论点涉及这种情况下 LT 证据质量的局限性——与研究设计以及患者特征和降期方案的异质性有关。虽然承认 LT 为门静脉肿瘤血栓形成患者提供了优越的结果，但反驳的观点是，此类患者的预期生存率仍低于 LT 可接受的阈值，事实上，其他接受移植的患者所达到的水平也超出了 LT 的预期水平。米兰标准。根据现有证据，共识指南推荐这种方法似乎还为时过早，但是，希望通过更高质量的证据和标准化的降期方案，LT 可能很快会得到更广泛的适应症，包括对于临床未满足率较高的人群需要。