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Transarterial Chemoembolization as a Bridge to Liver Transplantation for Hepatocellular Carcinoma: An Evidence‐Based Analysis
Author(s) -
Lesurtel M.,
Müllhaupt B.,
Pestalozzi B. C.,
Pfammatter T.,
Clavien P.A.
Publication year - 2006
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/j.1600-6143.2006.01509.x
Subject(s) - medicine , hepatocellular carcinoma , liver transplantation , grading (engineering) , randomized controlled trial , milan criteria , medline , transplantation , oncology , surgery , civil engineering , political science , law , engineering
The aim of this review was to assess the impact of transarterial chemoembolization (TACE) as a neoadjuvant therapy prior to orthotopic liver transplantation (OLT) for hepatocellular carcinoma (HCC). An electronic search on the Medline database (1990–2005) was used to identify relevant articles. The studies were reviewed and ranked according to their quality of evidence using the grading system proposed by the Oxford Centre for Evidence‐based Medicine. As a bridge to OLT, pretransplant TACE does not improve long‐term survival (grade C). There is currently no convincing evidence that TACE allows to expand the current selection criteria for OLT, nor that TACE decreases dropout rates on the waiting list (grade C). However, TACE does not increase the risk for postoperative complications (grade C). There is insufficient evidence that TACE offers any benefit when used prior to OLT, neither for early nor for advanced HCC. Well‐designed randomized controlled trials are needed to define the role of TACE in OLT patients.