Liver transplantation for advanced hepatocellular carcinoma after downstaging with consequential lenvatinib, transcatheter arterial chemoembolization and camrelizumab.

"Disclosure Dr Wei Peng reports receiving grant support from Zelgen and lecture fees from Bayer, Merk, Roche, Hengrui and SciClone. Dr Xiaoyun Zhang receives grant support from Innovent, Eisai and lecture fees from Bayer, Merk, Roche and Hengrui. Dr Chuan Li receives grant support from Eisai and Merk, and advisor board fees from Bayer, Merk and Roche. Dr Tianfu Wen reports receiving grant support from AstraZeneca, Zelgen, Merk, Roche, Eisai and Innovent, and advisory board fees and lecture fees from Bayer, Merk, Roche and Hengrui. No other potential conflict of interest was reported."

"Funding This study was funded by National Natural Science Foundation of China (Grant No. 82200691) and Key Research and Development Program of Sichuan Province (Grant No. 2022YFS0377)."

"LEN-TAP is an investigator-initiated trial that was designed to investigate efficacy and safety of salvage liver resection after conversion therapy of lenvatinib, TACE and PD-1 inhibitor in patients with unresectable HCC. The study protocol was approved by ethics committee of West China Hospital (2020-836) and the study was registered at ClinicalTrial.gov (NCT04997850). Details of LEN-TAP study design are available in . Clinical data of patients who opted for LT when they failed to receive salvage liver resection due to decompensated liver function after successful downstaging were reviewed and analysed. LT was suggested after several multidisciplinary team meetings based upon the following considerations: advanced stage disease was downstaged within Milan criteria and complete tumour necrosis was found on enhanced computed tomography; and decompensated liver function and high risk of posthepatectomy liver failure. Additional methods are shown in the supplementary file."