title: Presurgical transarterial chemoembolization does not increase biliary stricture incidence in orthotopic liver transplant patients.
abstract: BACKGROUND
  The goal of this study was to compare the incidence of biliary strictures in orthotopic liver transplant (OLT) patients treated with previous transarterial chemoembolization (TACE) versus those with no TACE history.
  
  
  METHODS
  A single-center retrospective review was performed on 248 patients who underwent OLT from 2006 to 2012. Patient demographic characteristics, history of TACE for treatment of hepatocellular carcinoma, OLT data, and biliary stricture data were obtained. TACE was generally performed in a segmental manner using chemotherapy to ethiodized oil mixture (1:1). Clinically significant biliary strictures resulting in cholestasis or obstructive jaundice were diagnosed by using endoscopic retrograde cholangiopancreatography. Group characteristics were compared by using the Wilcoxon rank sum test, χ(2) analysis, and Kaplan-Meier statistics with log-rank comparison.
  
  
  RESULTS
  Forty-six patients (35 men, 11 women; median age, 58 years) with a history of pre-OLT TACE were compared with 185 patients (111 men, 74 women; median age, 54 years) with no history of TACE. TACE and non-TACE patients had 30% and 31% cumulative incidence of biliary stricture, respectively. The median time to stricture was not reached in either group. There was no statistically significant difference in biliary stricture incidence (P = .928) or time to biliary stricture development (P = .803). Biliary strictures were primarily anastomotic in location in both groups: 79% in TACE patients and 84% in non-TACE patients (P = .233).
  
  
  CONCLUSIONS
  Selective TACE treatment of hepatocellular carcinoma in pretransplant patients does not increase the rate of posttransplant biliary strictures. These findings corroborate the safety of TACE in the treatment of hepatocellular carcinoma in potential OLT patients as a bridge to transplantation.
authors.affiliation: Division of Interventional Radiology, Department of Radiology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois.
authors.forename: L
authors.initials: L
authors.lastname: Casadaban
authors.affiliation: Division of Digestive Diseases and Nutrition, Department of Medicine, University of Illinois Hospital and Health Sciences System, Chicago, Illinois.
authors.forename: M
authors.initials: M
authors.lastname: Malespin
authors.affiliation: Department of Medicine, Section of Hepatology, Loyola University Medical Center, Section of Hepatology, Maywood, Illinois.
authors.forename: A
authors.initials: A
authors.lastname: Cheung
authors.affiliation: Division of Digestive Diseases and Nutrition, Department of Medicine, University of Illinois Hospital and Health Sciences System, Chicago, Illinois.
authors.forename: R A
authors.initials: RA
authors.lastname: McGuffey
authors.affiliation: Division of Digestive Diseases and Nutrition, Department of Medicine, University of Illinois Hospital and Health Sciences System, Chicago, Illinois.
authors.forename: B R
authors.initials: BR
authors.lastname: Boulay
authors.affiliation: Division of Digestive Diseases and Nutrition, Department of Medicine, University of Illinois Hospital and Health Sciences System, Chicago, Illinois.
authors.forename: A G
authors.initials: AG
authors.lastname: Halline
authors.affiliation: Division of Digestive Diseases and Nutrition, Department of Medicine, University of Illinois Hospital and Health Sciences System, Chicago, Illinois.
authors.forename: R D
authors.initials: RD
authors.lastname: Brown
authors.affiliation: Department of Medicine, Section of Hepatology, Loyola University Medical Center, Section of Hepatology, Maywood, Illinois.
authors.forename: S J
authors.initials: SJ
authors.lastname: Cotler
authors.affiliation: Division of Transplant Surgery, Department of Surgery, University of Illinois Hospital and Health Sciences System, Chicago, Illinois.
authors.forename: H
authors.initials: H
authors.lastname: Jeon
authors.affiliation: Division of Interventional Radiology, Department of Radiology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois.
authors.forename: J T
authors.initials: JT
authors.lastname: Bui
authors.affiliation: Division of Interventional Radiology, Department of Radiology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois. Electronic address: rgaba@uic.edu.
authors.forename: R C
authors.initials: RC
authors.lastname: Gaba
mesh_terms: D001659:Biliary Tract / Q000473:pathology*; D016461:Chemoembolization, Therapeutic; D003251:Constriction, Pathologic; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies