Impact of pre-operative transarterial embolization on the treatment of hepatocellular carcinoma with liver transplantation.
OBJECTIVE
To determine the effectiveness of pre-liver transplant (LT) transarterial embolization (TAE) in treating hepatocellular carcinoma (HCC) and the patient categories, which are likely to have a good outcome after LT.


METHODS
Twenty-nine patients with hepatitis-related cirrhosis and unresectable HCC after LT were studied over a 7-year period. The patients were divided into two groups: group A patients (19/29) received pre-LT TAE, whereas group B (10/29) underwent LT without prior TAE. According to Milan criteria, group A patients were further subdivided into: group A1 (12/19) who met the criteria, and group A2 (7/19) who did not. Patient survivals were compared.


RESULTS
In the explanted liver, CT images correlated well with pathological specimens showing that TAE induced massive tumor necrosis (>85%) in 63.1% of patients in group A and all 7 patients in group A2 exhibited tumor downgrading that met Milan criteria. The overall 5-year actuarial survival rate was 80.6%. The TAE group had a better survival (84% at 5 years) than the non-TAE (75% at 4 years). The 3-year survival of group A2 (83%) was also higher than that of group A1 (79%). Tumor necrosis >85% was associated with excellent survival of 100% at 3 years, which was significantly better than the others who showed <85% tumor necrosis (57.1% at 3 years) or who did not have TAE (75% at 3 years).


CONCLUSIONS
TAE is an effective treatment for HCC before LT. Excellent long-term survival was achieved in patients that did not fit Milan criteria. Our results broadened and redefined the selection policy for LT among patients with HCC. Meticulous pre-LT TAE helps in further reducing the rate of dropout from waiting lists and should be considered for patients with advanced HCC.
Cheng
Yu-Fan
YF
Department of Surgery, Chang Gung Memorial Hospital, 123 Taipei Road, Niao-Sung, Kaohsiung 83305, Taiwan, China. cheng.yufan@msa.hinet.net
Huang
Tung-Liang
TL
Chen
Tai-Yi
TY
Chen
Yaw-Sen
YS
Wang
Chih-Chi
CC
Hsu
Sheng-Lung
SL
Tsang
Leo Leung-Chit
LL
Sun
Po-Lin
PL
Chiu
King-Wah
KW
Jawan
Bruno
B
Eng
Hock-Liew
HL
Chen
Chao-Long
CL
D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care