title: Transarterial embolization as neo-adjuvant therapy pretransplantation in patients with hepatocellular carcinoma.
abstract: OBJECTIVE
  Neo-adjuvant transarterial therapies are commonly used for patients with HCC in the waiting list for liver transplantation (LT) to delay tumour progression, however, their effectiveness is not well-established. We studied the effect of pre-LT transarterial therapies on post-LT HCC recurrence, using the explanted liver histology to assess therapeutic efficacy and the predictors of response to these therapies.
  
  
  METHODS
  We included 150 consecutive patients from our prospectively compiled database, listed for liver transplantation using the Milan criteria. Transarterial embolization without chemotherapeutic agents was the transarterial therapy used as standard of care. PVA particles were the embolizing agent of choice.
  
  
  RESULTS
  Sixty-seven (45%) patients had TAE as bridging therapy to liver transplantation, of which 60 were transplanted after 2001. The majority of patients (36, 54%) had partial tumour necrosis after transarterial therapy, whereas 22 (33%) had complete tumour necrosis and 9 (13%) had no necrosis. HCC post-transplant recurrence was independently associated with no neo-adjuvant transarterial therapy (OR 5.395, 95% CI 1.289-22.577; P = 0.021) and the total radiological size of HCC nodules (OR 1.037, 95% CI 1.006-1.069; P = 0.020).
  
  
  CONCLUSIONS
  Pre-transplant TAE with the more permanently occluding PVA particles significantly reduces post-transplant HCC recurrence in patients within the Milan criteria.
authors.affiliation: The Royal Free Sheila Sherlock Liver Centre and UCL Institute of Liver and Digestive Health, Royal Free Hospital and UCL, London, UK.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Tsochatzis
authors.forename: Matteo
authors.initials: M
authors.lastname: Garcovich
authors.forename: Laura
authors.initials: L
authors.lastname: Marelli
authors.forename: Vassilis
authors.initials: V
authors.lastname: Papastergiou
authors.forename: Evangelia
authors.initials: E
authors.lastname: Fatourou
authors.forename: Manuel L
authors.initials: ML
authors.lastname: Rodriguez-Peralvarez
authors.forename: Giacomo
authors.initials: G
authors.lastname: Germani
authors.forename: Neil
authors.initials: N
authors.lastname: Davies
authors.forename: Dominic
authors.initials: D
authors.lastname: Yu
authors.forename: Tu Vinh
authors.initials: TV
authors.lastname: Luong
authors.forename: Amar P
authors.initials: AP
authors.lastname: Dhillon
authors.forename: Douglas
authors.initials: D
authors.lastname: Thorburn
authors.forename: David
authors.initials: D
authors.lastname: Patch
authors.forename: James
authors.initials: J
authors.lastname: O'Beirne
authors.forename: Tim
authors.initials: T
authors.lastname: Meyer
authors.forename: Andrew K
authors.initials: AK
authors.lastname: Burroughs
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000098:blood supply / Q000556:secondary / Q000601:surgery / Q000628:therapy*; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000098:blood supply / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D016031:Liver Transplantation; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009336:Necrosis; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local; D016017:Odds Ratio; D011142:Polyvinyl Alcohol / Q000008:administration & dosage*; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014850:Waiting Lists
chemical_list: D011142:Polyvinyl Alcohol