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©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Nov 27, 2025; 17(11): 110614
Published online Nov 27, 2025. doi: 10.4254/wjh.v17.i11.110614
Published online Nov 27, 2025. doi: 10.4254/wjh.v17.i11.110614
Pre-transplant downstaging strategies for hepatocellular carcinoma with portal vein tumor thrombus: Current therapies and future challenges
Zong-Yang Li, Cheng Xie, Hong-Qiao Cai, Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
Author contributions: Cai HQ designed the overall concept and outline of the manuscript; Li ZY contributed to the discussion and design of the manuscript; Xie C contributed to the writing, and editing the manuscript, illustrations, and review of literature.
Conflict-of-interest statement: The authors have claimed no conflicts.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hong-Qiao Cai, MD, PhD, Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, The First Hospital of Jilin University, No. 1 Xinmin Street, Changchun 130021, Jilin Province, China. hongqiaocai@jlu.edu.cn
Received: June 12, 2025
Revised: July 14, 2025
Accepted: September 28, 2025
Published online: November 27, 2025
Processing time: 169 Days and 3.4 Hours
Revised: July 14, 2025
Accepted: September 28, 2025
Published online: November 27, 2025
Processing time: 169 Days and 3.4 Hours
Core Tip
Core Tip: Hepatocellular carcinoma with portal vein tumor thrombus has long been considered a contraindication for liver transplantation due to poor prognosis. However, evolving downstaging strategies, including transarterial chemoembolization, transarterial radioembolization, proton beam therapy, and combination immunotherapies, have shown potential to convert select patients into transplant candidates. This review summarizes current clinical evidence and highlights future directions involving personalized medicine, novel biomaterials, and standardized criteria.