Hepatocellular carcinoma (HCC) is the most common primary malignancy of the liver accounting for 7% of all cancers worldwide. Most cases of HCC develop within an established background of chronic liver disease. For that reason, liver resection is only possible in selected patients. Liver transplantation has become the treatment of choice in patients with HCC, end-stage liver disease, and significant portal hypertension. Shortage of organ donors has resulted in overall increase of waiting list time with increased risk of dropout due to tumor progression. Neoadjuvant therapies have emerged as an alternative to control tumor growth in patients while waiting. The aim of this study is to review the literature on the role of bridging therapy and downstaging prior to liver transplantation in patients with HCC. We are also presenting our single-center experience of 96 patients undergoing transplantation for HCC with and without bridging therapy. 1. Introduction Hepatocellular carcinoma (HCC) is the most common primary malignancy of the liver, the sixth most common cancer (749,000 new cases each year), and the third cause of cancer-related death worldwide [1]. In the western world, most cases of HCC develop within an established background of chronic liver disease and portal hypertension (70%–90% of all patients). Liver resection is only possible in selected cases due to the high incidence of morbidity and mortality in patients with cirrhosis and elevated portal pressures. Liver transplantation (LT) has become the treatment of choice for patients with HCC and end-stage liver disease, as it has the advantage of eradicating the tumor and the premalignant cirrhotic liver. Recurrence after LT ranges from 8% to 15% when a specific criterion for selection of patients is used. Surgical resection and ablation therapies have been associated with much higher rates of recurrence [2]. After Milan criteria were established (single nodule less than 5？cm or 3 nodules less than 3？cm), excellent results have been reported with survival in the range of 60%–70% at 5 years [3, 4]. Nonetheless, shortage of organ donors is increasing the waiting time and consequently leading to 30%–40% dropout per year because of tumor progression [5]. Therefore, the practice of treating HCC patients with locoregional therapies before LT, as they are waiting to be transplanted, has become standard in most centers [6]. We reviewed the literature on the use of locoregional therapies prior to liver transplantation and analyzed patients undergoing transplantation for HCC in our institution with emphasis
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