What is the principal aim of downstaging strategies in hepatocellular carcinoma before liver transplantation?

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Downstaging before liver transplantation aims to reduce tumor burden to fit established transplant criteria and improve post-transplant outcomes. By using locoregional therapies to shrink or control hepatocellular carcinoma, patients who initially exceed criteria may become eligible for transplant. This approach also helps reveal tumor biology—patients whose disease is controlled during downstaging tend to have better survival and lower recurrence after transplantation. It is not about expanding tumor burden, avoiding transplantation, or reducing the need for adjuvant therapy; the goal is to enable transplantation with favorable results by bringing the disease within acceptable limits.