Premium
Transarterial embolization as neo‐adjuvant therapy pretransplantation in patients with hepatocellular carcinoma
Author(s) -
Tsochatzis Emmanuel,
Garcovich Matteo,
Marelli Laura,
Papastergiou Vassilis,
Fatourou Evangelia,
RodriguezPeralvarez Manuel L.,
Germani Giacomo,
Davies Neil,
Yu Dominic,
Luong Tu Vinh,
Dhillon Amar P.,
Thorburn Douglas,
Patch David,
O'Beirne James,
Meyer Tim,
Burroughs Andrew K.
Publication year - 2013
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.12144
Subject(s) - medicine , hepatocellular carcinoma , transarterial embolization , milan criteria , liver transplantation , adjuvant therapy , adjuvant , necrosis , transplantation , surgery , embolization , gastroenterology , chemotherapy
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.