Open AccessLiver transplantation outcomes after transarterial chemotherapy for hepatocellular carcinoma
Author(s) -
Wallace D.,
Cowling T. E.,
Walker K.,
Suddle A.,
Gimson A.,
Rowe I.,
Callaghan C.,
Sapisochin G.,
Mehta N.,
Heaton N.,
van der Meulen J.
Publication year - 2020
Publication title -
british journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.202
H-Index - 201
eISSN - 1365-2168
pISSN - 0007-1323
DOI - 10.1002/bjs.11559
Subject(s) - medicine , hepatocellular carcinoma , liver transplantation , hazard ratio , transplantation , incidence (geometry) , proportional hazards model , surgery , gastroenterology , carcinoma , chemotherapy , portal vein thrombosis , thrombosis , confidence interval , physics , optics
Background Transarterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC) awaiting liver transplantation is widespread, although evidence that it improves outcomes is lacking and there exist concerns about morbidity. The impact of TACE on outcomes after transplantation was evaluated in this study. Methods Patients with HCC who had liver transplantation in the UK were identified, and stratified according to whether they received TACE between 2006 and 2016. Cox regression methods were used to estimate hazard ratios (HRs) for death and graft failure after transplantation adjusted for donor and recipient characteristics. Results In total, 385 of 968 patients (39·8 per cent) received TACE. Five‐year patient survival after transplantation was similar in those who had or had not received TACE: 75·2 (95 per cent c.i. 68·8 to 80·5) and 75·0 (70·5 to 78·8) per cent respectively. After adjustment for donor and recipient characteristics, there were no differences in mortality (HR 0·96, 95 per cent c.i. 0·67 to 1·38; P = 0·821) or graft failure (HR 1·01, 0·73 to 1·40; P = 0·964). The number of TACE treatments (2 or more versus 1: HR 0·97, 0·61 to 1·55; P = 0·903) or the time of death after transplantation (within or after 90 days; P = 0·291) did not alter the outcome. The incidence of hepatic artery thrombosis was low in those who had or had not received TACE (1·3 and 2·4 per cent respectively; P = 0·235). Conclusion TACE delivered to patients with HCC before liver transplant did not affect complications, patient death or graft failure after transplantation.