title: Role of Locoregional Therapy and Predictors for Dropout in Patients with Hepatocellular Carcinoma Listed for Liver Transplantation.
abstract: OBJECTIVE
  To identify factors associated with removal from the liver transplantation waitlist because of death, deterioration of condition, or exceeding Milan criteria in patients with hepatocellular carcinoma (HCC), with emphasis on the role of locoregional therapy (LRT), defined as percutaneous thermal ablation and drug-eluting embolic chemoembolization, as bridge therapy.
  
  
  METHODS
  All patients listed for liver transplant at a single institution with exception points for HCC during 2004-2012 were evaluated. The most common cause of cirrhosis was hepatitis C (68%; 121/177). Seventy-one percent (125/177) of patients underwent liver transplantation, and 83% (147/177) underwent at least 1 LRT procedure. Of the 52 patients who did not undergo liver transplantation, 31 (60%) of livers were removed because of progression of HCC.
  
  
  RESULTS
  The likelihood of transplant was higher for patients who received LRT (odds ratio [OR], 2.9; confidence interval [CI], 2.2-7.2) and lower for patients with multifocal tumors (OR, 0.25; CI, 0.12-0.52) and with larger tumors (OR, 0.94; CI, 0.90-0.98). Time on the waitlist (OR, 0.99; CI, 0.99-1.0) was not found to correlate with removal. LRT increased the likelihood of liver transplantation, specifically for patients with prolonged wait times. Patients who demonstrated complete response (CR) to LRT on the first follow-up imaging study were more likely to undergo liver transplantation.
  
  
  CONCLUSIONS
  LRT increased the likelihood of a patient with HCC achieving liver transplant, particularly in patients facing prolonged waiting times. CR after LRT significantly increased the likelihood of liver transplantation.
authors.affiliation: Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, FND 216, 55 Fruit Street, Boston, MA 02114. Electronic address: rsheth@partners.org.
authors.forename: Rahul A
authors.initials: RA
authors.lastname: Sheth
authors.affiliation: Department of Transplant Surgery, Massachusetts General Hospital, FND 216, 55 Fruit Street, Boston, MA 02114.
authors.forename: Madhukar S
authors.initials: MS
authors.lastname: Patel
authors.affiliation: Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, FND 216, 55 Fruit Street, Boston, MA 02114.
authors.forename: Brian
authors.initials: B
authors.lastname: Koottappillil
authors.affiliation: Department of Transplant Surgery, Massachusetts General Hospital, FND 216, 55 Fruit Street, Boston, MA 02114.
authors.forename: Jigesh A
authors.initials: JA
authors.lastname: Shah
authors.affiliation: Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, FND 216, 55 Fruit Street, Boston, MA 02114.
authors.forename: Rahmi
authors.initials: R
authors.lastname: Oklu
authors.affiliation: Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, FND 216, 55 Fruit Street, Boston, MA 02114.
authors.forename: Peter
authors.initials: P
authors.lastname: Mueller
authors.affiliation: Department of Transplant Surgery, Massachusetts General Hospital, FND 216, 55 Fruit Street, Boston, MA 02114.
authors.forename: Parsia A
authors.initials: PA
authors.lastname: Vagefi
authors.affiliation: Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, FND 216, 55 Fruit Street, Boston, MA 02114.
authors.forename: Suvranu
authors.initials: S
authors.lastname: Ganguli
mesh_terms: D000328:Adult; D000368:Aged; D001900:Boston / Q000453:epidemiology; D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000523:psychology / Q000628:therapy*; D003131:Combined Modality Therapy / Q000401:mortality / Q000523:psychology; D004621:Embolization, Therapeutic / Q000379:methods / Q000523:psychology; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced / Q000401:mortality / Q000523:psychology; D008113:Liver Neoplasms / Q000401:mortality* / Q000523:psychology / Q000628:therapy*; D016031:Liver Transplantation / Q000401:mortality* / Q000523:psychology / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010352:Patient Dropouts / Q000523:psychology / Q000706:statistics & numerical data*; D015995:Prevalence; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome; D014850:Waiting Lists / Q000401:mortality