Amante MF, Vargas Wille MF, Pestalardo ML. Multifaceted role of histopathology in liver transplantation for hepatocellular carcinoma: A narrative review towards precision prognosis. World J Transplant 2026; 16(2): 115879 [DOI: 10.5500/wjt.v16.i2.115879]
Corresponding Author of This Article
Marcelo Fabián Amante, MD, División Patología, Hospital General de Agudos Cosme Argerich, Pi y Margall 480, Buenos Aires C1155AHA, Ciudad Autónoma de, Argentina. marcelofabianamante@gmail.com
Research Domain of This Article
Pathology
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editorial
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Amante MF, Vargas Wille MF, Pestalardo ML. Multifaceted role of histopathology in liver transplantation for hepatocellular carcinoma: A narrative review towards precision prognosis. World J Transplant 2026; 16(2): 115879 [DOI: 10.5500/wjt.v16.i2.115879]
World J Transplant. Jun 18, 2026; 16(2): 115879 Published online Jun 18, 2026. doi: 10.5500/wjt.v16.i2.115879
Multifaceted role of histopathology in liver transplantation for hepatocellular carcinoma: A narrative review towards precision prognosis
Marcelo Fabián Amante, María Fernanda Vargas Wille, María L Pestalardo
Marcelo Fabián Amante, María L Pestalardo, Department of División Patología, Hospital General de Agudos Cosme Argerich, Buenos Aires C1155AHA, Ciudad Autónoma de, Argentina
María Fernanda Vargas Wille, Department of Pathology, Hospital Enrique Baltodano Briceño, Liberia 50101, Guanacaste, Costa Rica
Author contributions: Amante MF and Pestalardo ML conceptualized and designed the study, created the artwork, supervised the study, and made critical revisions; Vargas Wille MF conducted the literature review, performed the analyses and interpretation of the data, and drafted the original manuscript. All authors prepared the draft manuscript and approved the submitted version.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Marcelo Fabián Amante, MD, División Patología, Hospital General de Agudos Cosme Argerich, Pi y Margall 480, Buenos Aires C1155AHA, Ciudad Autónoma de, Argentina. marcelofabianamante@gmail.com
Received: October 28, 2025 Revised: November 19, 2025 Accepted: February 3, 2026 Published online: June 18, 2026 Processing time: 213 Days and 20.8 Hours
Abstract
Hepatocellular carcinoma is a leading cause of cancer mortality globally. Liver transplantation is considered the best curative treatment for selected patients, as it removes the tumor and restores hepatic function. However, organ scarcity requires precise prognostic stratification. Histopathology is the essential bridge between morphology and biology, offering unique insights into tumor aggressiveness that imaging cannot capture. Öztürk et al recently published a study in the World Journal of Transplantation, analyzing a large United States transplant cohort analysis, which reveals clear differences in the risk profiles of macrovascular invasion and microvascular invasion. A central prognostic factor is macrovascular invasion. Macrovascular invasion indicates a poor prognosis, whereas microvascular invasion, detectable only histologically, defines an intermediate risk, highlighting the need for meticulous and standardized pathological examination. Prognostic accuracy is further refined by factors such as histological grading and specific subtypes (e.g., macrotrabecular-massive). Histopathological data guide clinical decision-making throughout the transplant process, from candidate selection to individualized surveillance. The incorporation of microvascular invasion or poor differentiation into predictive models improves patient management. In the future, digital pathology and artificial intelligence will automate the detection of prognostic markers, while molecular profiling will deepen our understanding of tumors at the morpho-molecular level. Within this integrated framework, histopathology has evolved into a dynamic science that is essential for the implementation of precision medicine for liver transplantation in cases of hepatocellular carcinoma. The liver explant has become a valuable repository of biological information that informs risk, guides therapy, and expands the field of transplant oncology.
Core Tip: Histopathological assessment remains indispensable for liver transplantation in hepatocellular carcinoma, providing crucial information about tumor biology that imaging alone cannot capture. This editorial emphasizes how vascular invasion, tumor differentiation, and histologic subtyping critically refine prognostic stratification and guide individualized post-transplant management. By integrating standardized sampling with digital pathology and molecular profiling, pathology evolves from a diagnostic discipline into a predictive and decision-shaping science, optimizing organ allocation for hepatocellular carcinoma transplantation and improving long-term outcomes for patients.
