Liver Cancer

Transarterial embolization as neo-adjuvant therapy pretransplantation in patients with hepatocellular carcinoma

  1. Emmanuel Tsochatzis1,
  2. Matteo Garcovich1,
  3. Laura Marelli1,
  4. Vassilis Papastergiou1,
  5. Evangelia Fatourou1,
  6. Manuel L. Rodriguez-Peralvarez1,
  7. Giacomo Germani1,
  8. Neil Davies2,
  9. Dominic Yu2,
  10. Tu Vinh Luong3,
  11. Amar P. Dhillon3,
  12. Douglas Thorburn1,
  13. David Patch1,
  14. James O'Beirne1,
  15. Tim Meyer4,
  16. Andrew K. Burroughs1,*

Article first published online: 26 MAR 2013

DOI: 10.1111/liv.12144

Additional Information

How to Cite

Tsochatzis, E., Garcovich, M., Marelli, L., Papastergiou, V., Fatourou, E., Rodriguez-Peralvarez, M. L., Germani, G., Davies, N., Yu, D., Luong, T. V., Dhillon, A. P., Thorburn, D., Patch, D., O'Beirne, J., Meyer, T. and Burroughs, A. K. (2013), Transarterial embolization as neo-adjuvant therapy pretransplantation in patients with hepatocellular carcinoma. Liver International. doi: 10.1111/liv.12144

Author Information

  1. 1

    The Royal Free Sheila Sherlock Liver Centre and UCL Institute of Liver and Digestive Health, Royal Free Hospital and UCL, London, UK

  2. 2

    Department of Cellular Pathology, UCL Medical School, Royal Free Campus, London, UK

  3. 3

    Department of Radiology, Royal Free Hospital, London, UK

  4. 4

    Department of Oncology, Royal Free Hospital and UCL, London, UK

* Correspondence
Professor Andrew K. Burroughs, The Royal Free Sheila Sherlock Liver Centre and UCL Institute of Liver and Digestive Health,
UCL and Royal Free Hospital, Pond Street, Hampstead, London NW3 2QG, UK
Tel: +44 2074726229
Fax: +44 2074726226
e-mail: andrew.burroughs@nhs.net

Publication History

  1. Article first published online: 26 MAR 2013
  2. Accepted manuscript online: 20 FEB 2013 09:46AM EST
  3. Manuscript Accepted: 14 FEB 2013
  4. Manuscript Received: 21 AUG 2012

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Keywords:

  • TAE;
  • TACE;
  • HCC;
  • liver transplant;
  • survival;
  • recurrence

Abstract

Background & Aims

Neo-adjuvant transarterial therapies are commonly used for patients with HCC in the waiting list for liver transplantation (LT) to delay tumour progression, however, their effectiveness is not well-established. We studied the effect of pre-LT transarterial therapies on post-LT HCC recurrence, using the explanted liver histology to assess therapeutic efficacy and the predictors of response to these therapies.

Methods

We included 150 consecutive patients from our prospectively compiled database, listed for liver transplantation using the Milan criteria. Transarterial embolization without chemotherapeutic agents was the transarterial therapy used as standard of care. PVA particles were the embolizing agent of choice.

Results

Sixty-seven (45%) patients had TAE as bridging therapy to liver transplantation, of which 60 were transplanted after 2001. The majority of patients (36, 54%) had partial tumour necrosis after transarterial therapy, whereas 22 (33%) had complete tumour necrosis and 9 (13%) had no necrosis. HCC post-transplant recurrence was independently associated with no neo-adjuvant transarterial therapy (OR 5.395, 95% CI 1.289–22.577; P = 0.021) and the total radiological size of HCC nodules (OR 1.037, 95% CI 1.006–1.069; P = 0.020).

Conclusions

Pre-transplant TAE with the more permanently occluding PVA particles significantly reduces post-transplant HCC recurrence in patients within the Milan criteria.

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