title: Prior Trans-arterial chemoembolization - A protective factor against rapid HCV recurrence post liver transplant in patients with HCV with HCC? - A Retrospective Cohort Study.
abstract: BACKGROUND
  HCV recurrence after liver transplant is nearly universal and results in progressive fibrosis, cirrhosis, graft loss, retransplantation and mortality. There are very few studies comparing impact of pretransplant HCC therapies either as a bridge to transplant or to downstage like TACE, hepatectomy, RFA, PEI on HCV recurrence post transplant. Primary aim of the study was studying prognostic factors associated with HCV recurrence including pre transplant HCC therapies.
  
  
  METHODS
  All the patients who have undergone living donor liver transplantation at Kaohsiung Chang gung memorial hospital, Taiwan for HCV related HCC between July 2002 and June 2012 were analyzed retrospectively. Severity of HCV histological recurrence was categorized according to the ISHAK hepatitis activity index score. Rapid HCV recurrence was defined ISHAK hepatitis activity index (HAI) score greater than 4 at one year. Statistical analysis was done using SPSS version 21. (IBM).
  
  
  RESULTS
  One hundred and nine patients with HCC associated with HCV undergo living donor liver transplant from July 2002 to June 2012. Median follow up time was 31 months. Forty nine patient had significant hepatitis c recurrence at the end of one year (HAI >4) and were included in study group.60 patients without significant hepatitis c recurrence were included in control group. On univariate analysis patients who did not undergo pre-transplant trans arterial chemoembolization (0.035), primary transplant (without prior hepatectomy) (p = 0.031), high meld score (p = 0.036), high viral load pretransplant (0.007), High AFP levels (0.013) were significantly associated with rapid histological recurrence of HCV (HAI greater than 4 at one year post transplant). Total 61 patient underwent prior transarterial chemoembolization, 22 of these patients developed significant HCV recurrence while 39 patient did not developed HCV recurrence. On multivariate analysis only patient who did not undergo TACE were significantly associated with rapid histological recurrence of HCV (odds ratio 3.310, p = 0.018 95% confidence interval 1.22-8.94).
  
  
  CONCLUSIONS
  Prior TACE do not increase post transplant HCV recurrence but may be beneficial for it.
authors.affiliation: Hepato-pancreatico-biliary and Liver Transplant, Sunshine Global Hospitals, Surat, India. Electronic address: drbhavin.liversurgeon@gmail.com.
authors.forename: Bhavin
authors.initials: B
authors.lastname: Vasavada
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage; D006528:Carcinoma, Hepatocellular / Q000601:surgery* / Q000821:virology; D016461:Chemoembolization, Therapeutic; D003287:Contrast Media / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D004998:Ethiodized Oil / Q000008:administration & dosage; D005260:Female; D006498:Hepatectomy; D019698:Hepatitis C, Chronic / Q000150:complications / Q000601:surgery*; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery* / Q000821:virology; D016031:Liver Transplantation / Q000009:adverse effects*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies
chemical_list: D000970:Antineoplastic Agents; D003287:Contrast Media; D004998:Ethiodized Oil; D004317:Doxorubicin
keywords: HCC; HCV; Hepatitis c virus; Hepatocellular carcinoma; Liver transplantation; TACE; Transarterial chemoembolization