Loco-regional therapy in patients with Milan Criteria-compliant hepatocellular carcinoma and short waitlist time to transplant: an outcome analysis


  • This study was presented in part as a poster presentation at Digestive Disease Week, 7–11 May 2011, Chicago, Illinois.

Achuthan Sourianarayanane, Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic Foundation, A51, 9500 Euclid Avenue, Cleveland, OH 44195, USA. Tel: + 1 216 444 6126. Fax: + 1 216 445 5477. E-mail: souriaa@ccf.org


Objectives:  Liver transplantation (LT) in Milan Criteria (MC) hepatocellular carcinoma (HCC) has excellent outcomes. Pre-transplant loco-regional therapy (LRT) has been used to downstage HCC to meet the MC. However, its benefit in patients with a brief waiting time to transplant remains unclear. This study evaluated outcomes in patients with short waitlist times to LT for MC-compliant HCC.

Methods:  Patients undergoing LT for MC HCC at either of two transplant centres between 2002 and 2009 were retrospectively evaluated for outcome. Patients for whom post-transplant follow-up amounted to <12 months were excluded.

Results:  A total of 225 patients were included, 93 (41.3%) of whom received neoadjuvant LRT. The median waiting time to transplant was 48 days. Mean post-transplant follow-up was 32.2 months. Overall and disease-free survival at 1 year, 3 years and 5 years were 93.1%, 82.4% and 72.6%, and 91.3%, 79.3% and 70.6%, respectively. There was no difference in overall (P= 0.94) and disease-free survival (P= 0.94) between groups who received and did not receive pre-LT LRT. There were also no disparities in survival or tumour recurrence among categories of patients (with single tumours measuring <3 cm, with single tumours measuring 3–5 cm, with multiple tumours).

Conclusions:  Loco-regional therapy followed by rapid transplantation in MC HCC appears not to have an impact on post-transplant outcome.