Transarterial embolization as neo-adjuvant therapy pretransplantation in patients with hepatocellular carcinoma
Article first published online: 26 MAR 2013
© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Volume 33, Issue 6, pages 944–949, July 2013
How to Cite
Liver Int. 2013: 33: 944–949
- Issue published online: 9 JUN 2013
- Article first published online: 26 MAR 2013
- Accepted manuscript online: 20 FEB 2013 09:46AM EST
- Manuscript Accepted: 14 FEB 2013
- Manuscript Received: 21 AUG 2012
- liver transplant;
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.
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.
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).
Pre-transplant TAE with the more permanently occluding PVA particles significantly reduces post-transplant HCC recurrence in patients within the Milan criteria.