Can AI Guide the Decision to Transplant or Resect for Hepatocellular Carcinoma?

Liver transplantation (LT) offers superior outcomes compared with surgical resection (SR) in the subgroup of patients with hepatocellular carcinoma (HCC), particularly those with underlying synthetic dysfunction, cirrhosis, and portal hypertension. 1The drawbacks of LT are the limited availability of donors, making waiting time for curative treatment unpredictable, and long-term morbidity that is associated with lifelong immunosuppression.The study by Kim et al 2 aimed to develop and validate a machine learning (ML) decision model to optimize the selection of patients with HCC for LT vs SR.Data for derivation cohort of 3915 patients who underwent LT or SR for HCC between 2008 and 2018 were obtained from the Korea Central Cancer Registry.The external validation cohort data were retrospectively collected from Seoul St Mary's Hospital for 614 patients who underwent treatment for HCC between 2009 and 2020.Six ML algorithms were applied to estimate 3-year overall survival (OS) by using demo-