title: Impact of pre-operative transarterial embolization on the treatment of hepatocellular carcinoma with liver transplantation.
abstract: 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.
authors.affiliation: Department of Surgery, Chang Gung Memorial Hospital, 123 Taipei Road, Niao-Sung, Kaohsiung 83305, Taiwan, China. cheng.yufan@msa.hinet.net
authors.forename: Yu-Fan
authors.initials: YF
authors.lastname: Cheng
authors.forename: Tung-Liang
authors.initials: TL
authors.lastname: Huang
authors.forename: Tai-Yi
authors.initials: TY
authors.lastname: Chen
authors.forename: Yaw-Sen
authors.initials: YS
authors.lastname: Chen
authors.forename: Chih-Chi
authors.initials: CC
authors.lastname: Wang
authors.forename: Sheng-Lung
authors.initials: SL
authors.lastname: Hsu
authors.forename: Leo Leung-Chit
authors.initials: LL
authors.lastname: Tsang
authors.forename: Po-Lin
authors.initials: PL
authors.lastname: Sun
authors.forename: King-Wah
authors.initials: KW
authors.lastname: Chiu
authors.forename: Bruno
authors.initials: B
authors.lastname: Jawan
authors.forename: Hock-Liew
authors.initials: HL
authors.lastname: Eng
authors.forename: Chao-Long
authors.initials: CL
authors.lastname: Chen
mesh_terms: 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