Radiofrequency thermal ablation of hepatocellular carcinoma before liver transplantation--a clinical and histological examination.
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.
Martin
Adrian P
AP
Baylor Regional Transplant Institute, Dallas, TX, USA.
Goldstein
Robert M
RM
Dempster
Jane
J
Netto
George J
GJ
Katabi
Nora
N
Derrick
Howard C
HC
Altrabulsi
Basel
B
Jennings
Linda W
LW
Ueno
Takehisa
T
Chinnakotla
Srinath
S
Dawson
Sherfield
S
Randall
Henry B
HB
Levy
Marlon F
MF
Onaca
Nicholas
N
Sanchez
Edmund Q
EQ
Orr
Douglas
D
Klintmalm
Goran B
GB
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