title: Disease course after liver transplantation for hepatocellular carcinoma in patients with complete tumor necrosis in liver explants after performance of bridging treatments.
abstract: OBJECTIVE
  To study the disease course of patients with hepatocellular carcinoma (HCC) showing complete tumor necrosis in their liver explants after undergoing bridging treatments followed by liver transplantation (LTx).
  
  
  METHODS
  We evaluated data corresponding to 10 patients with liver cirrhosis undergoing bridging treatments for HCC prior to LTx. In all cases there was complete tumor necrosis in the explanted livers.
  
  
  RESULTS
  There were 8 men and 2 women. Percutaneous radiofrequency ablation (RFA) was performed under computed tomographic guidance in 4 patients. The remaining 6 patients underwent transarterial chemoembolization (TACE). Five of them received one session of TACE, while the remaining one received a series of 4 sessions prior to LTx. Six patients had solitary nodules with a median diameter of 3.5 cm (range 2.5-4.2 cm). Four of them underwent RFA. Segmental tumor chemoembolization was performed in 2 patients. The remaining 4 patients had 2 tumors each with a median total diameter of 4.4cm (range 4.2-6.0 cm) prior to TACE. They underwent bilobar hepatic chemoembolization, which under staged the tumors prior to live donor liver transplantation (LDLTx). Six patients underwent deceased donor orthotopic liver transplantation. LDLTx was performed in 4 patients. Median waiting time to LTx was 53 days. All patients are alive without recurrence after a median follow-up of 19 months.
  
  
  CONCLUSIONS
  Achievement of 100% tumor necrosis by means of bridging treatments followed by LTx for HCC is characterized by a very low recurrence rate and should receive further consideration and study.
authors.affiliation: Department of General Surgery and Transplantation, University Hospital Essen, Germany. georgios.sotiropoulos@uni-essen.de
authors.forename: Georgios C
authors.initials: GC
authors.lastname: Sotiropoulos
authors.forename: M
authors.initials: M
authors.lastname: Malago
authors.forename: E P
authors.initials: EP
authors.lastname: Molmenti
authors.forename: A
authors.initials: A
authors.lastname: Radtke
authors.forename: E I
authors.initials: EI
authors.lastname: Brokalaki
authors.forename: S
authors.initials: S
authors.lastname: Nadalin
authors.forename: H
authors.initials: H
authors.lastname: Lang
authors.forename: A
authors.initials: A
authors.lastname: Frilling
authors.forename: H A
authors.initials: HA
authors.lastname: Baba
authors.forename: H
authors.initials: H
authors.lastname: Kühl
authors.forename: R
authors.initials: R
authors.lastname: Verhagen
authors.forename: C E
authors.initials: CE
authors.lastname: Broelsch
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000628:therapy*; D017115:Catheter Ablation / Q000379:methods*; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000473:pathology / Q000601:surgery*; D008113:Liver Neoplasms / Q000473:pathology / Q000628:therapy*; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D011300:Preoperative Care