title: Loco-regional therapy in patients with Milan Criteria-compliant hepatocellular carcinoma and short waitlist time to transplant: an outcome analysis.
abstract: OBJECTIVE
  Liver transplantation (LT) in Milan Criteria (MC) hepatocellular carcinoma (HCC) has excellent outcomes. Pre-transplant loco-regional therapy (LRT) has been used to downstage HCC to meet the MC. However, its benefit in patients with a brief waiting time to transplant remains unclear. This study evaluated outcomes in patients with short waitlist times to LT for MC-compliant HCC.
  
  
  METHODS
  Patients undergoing LT for MC HCC at either of two transplant centres between 2002 and 2009 were retrospectively evaluated for outcome. Patients for whom post-transplant follow-up amounted to <12 months were excluded.
  
  
  RESULTS
  A total of 225 patients were included, 93 (41.3%) of whom received neoadjuvant LRT. The median waiting time to transplant was 48 days. Mean post-transplant follow-up was 32.2 months. Overall and disease-free survival at 1 year, 3 years and 5 years were 93.1%, 82.4% and 72.6%, and 91.3%, 79.3% and 70.6%, respectively. There was no difference in overall (P= 0.94) and disease-free survival (P= 0.94) between groups who received and did not receive pre-LT LRT. There were also no disparities in survival or tumour recurrence among categories of patients (with single tumours measuring <3 cm, with single tumours measuring 3-5 cm, with multiple tumours).
  
  
  CONCLUSIONS
  Loco-regional therapy followed by rapid transplantation in MC HCC appears not to have an impact on post-transplant outcome.
authors.affiliation: Departments of Gastroenterology and Hepatology Transplant Surgery, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA. souriaa@ccf.org
authors.forename: Achuthan
authors.initials: A
authors.lastname: Sourianarayanane
authors.forename: Galal
authors.initials: G
authors.lastname: El-Gazzaz
authors.forename: Juan R
authors.initials: JR
authors.lastname: Sanabria
authors.forename: K V Narayanan
authors.initials: KV
authors.lastname: Menon
authors.forename: Cristiano
authors.initials: C
authors.lastname: Quintini
authors.forename: Koji
authors.initials: K
authors.lastname: Hashimoto
authors.forename: Dympna
authors.initials: D
authors.lastname: Kelly
authors.forename: Bijan
authors.initials: B
authors.lastname: Eghtesad
authors.forename: Charles
authors.initials: C
authors.lastname: Miller
authors.forename: John
authors.initials: J
authors.lastname: Fung
authors.forename: Federico
authors.initials: F
authors.lastname: Aucejo
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D016009:Chi-Square Distribution; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000009:adverse effects / Q000401:mortality; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D009820:Ohio; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014850:Waiting Lists