title: Radiofrequency thermal ablation of hepatocellular carcinoma before liver transplantation--a clinical and histological examination.
abstract: BACKGROUND
  Radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC) is an optional treatment for patients awaiting liver transplantation (LTX). The study evaluates the efficacy of RFA in the explanted liver and its effect on patient outcome.
  
  
  METHODS
  Forty-seven patients underwent RFA and were listed for transplant between January 1998 and May 2003. The patients were divided into two groups: transplanted and non-transplanted. Both groups were evaluated in terms of tumor characteristics, recurrence, mortality rate, and time on the waiting list. The ablation sites in the explanted livers were examined for percentage of necrosis by Hematoxylin & Eosin (H&E) stain and by TUNEL stain.
  
  
  RESULTS
  Transplantation was carried out in 35 patients (74.5%). Ten patients (21.3%) died before transplant or were removed from the wait list, while two patients (4.2%) are still listed. Mortality and tumor-related mortality were significantly higher in the non-transplanted group. The time spent on the waiting list was longer in the non-transplanted patients (350 vs. 186 d average, p = 0.0345). Thirty-eight ablation sites were examined in the explanted livers. The percentage of tumor necrosis by TUNEL staining was 19.6% higher than that reported by H&E staining. After TUNEL staining, 28 sites (73.7%) had more than 90% necrosis, eight sites (21.0%) had 50-90%, and two sites (5.3%) had less than 50% necrosis.
  
  
  CONCLUSIONS
  RFA and LTX can be used successfully in HCC patients, and in most cases, tumor necrosis can be achieved with ultrasound-guided RFA. H&E stain tends to under-represent the amount of tumor necrosis on the ablation sites. Survival of RFA patients after LTX is excellent.
authors.affiliation: Baylor Regional Transplant Institute, Dallas, TX, USA.
authors.forename: Adrian P
authors.initials: AP
authors.lastname: Martin
authors.forename: Robert M
authors.initials: RM
authors.lastname: Goldstein
authors.forename: Jane
authors.initials: J
authors.lastname: Dempster
authors.forename: George J
authors.initials: GJ
authors.lastname: Netto
authors.forename: Nora
authors.initials: N
authors.lastname: Katabi
authors.forename: Howard C
authors.initials: HC
authors.lastname: Derrick
authors.forename: Basel
authors.initials: B
authors.lastname: Altrabulsi
authors.forename: Linda W
authors.initials: LW
authors.lastname: Jennings
authors.forename: Takehisa
authors.initials: T
authors.lastname: Ueno
authors.forename: Srinath
authors.initials: S
authors.lastname: Chinnakotla
authors.forename: Sherfield
authors.initials: S
authors.lastname: Dawson
authors.forename: Henry B
authors.initials: HB
authors.lastname: Randall
authors.forename: Marlon F
authors.initials: MF
authors.lastname: Levy
authors.forename: Nicholas
authors.initials: N
authors.lastname: Onaca
authors.forename: Edmund Q
authors.initials: EQ
authors.lastname: Sanchez
authors.forename: Douglas
authors.initials: D
authors.lastname: Orr
authors.forename: Goran B
authors.initials: GB
authors.lastname: Klintmalm
mesh_terms: D001706:Biopsy; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D015994:Incidence; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods* / Q000401:mortality; D008279:Magnetic Resonance Imaging; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000473:pathology; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome