title: Pretransplant Locoregional Therapy for Hepatocellular Carcinoma: Evaluation of Explant Pathology and Overall Survival.
abstract: OBJECTIVE
  Liver transplant is an important treatment option for patients with hepatocellular carcinoma (HCC) within Milan criteria. We sought to determine the rate of complete tumor necrosis after bridging therapy.
  
  
  METHODS
  The medical records of all 178 patients undergoing liver transplantation between January 1, 2008 and July 31, 2015 were reviewed. Response to therapy by imaging was based on mRECIST criteria (1).
  
  
  RESULTS
  Sixty-three (35%) patients had HCC. Forty-three (68%) were treated with at least one bridging therapy and 14 (22%) were diagnosed incidentally. Eighteen (42%) underwent TACE and 25 (58%) underwent ablation. Twenty (80%) patients who underwent ablation and nine (60%) who underwent TACE had complete response based on imaging. Viable tumor was identified in explant pathology in 32 patients (74%). The presence or absence of viable tumor was not associated with overall survival.
  
  
  CONCLUSIONS
  Rates of viable tumor based on pathologic analysis in the hepatic explant were high after bridging therapy, but not associated with worse outcome. We conclude that serial bridging to achieve complete pathologic tumor response is not needed prior to transplant for HCC, and presence of complete response by imaging is adequate. Further studies are needed to determine if cancer cells that appear viable are alive.
authors.affiliation: Department of Surgery, The Ohio State University Wexner Medical Center, James Cancer Hospital , Columbus, OH , USA.
authors.forename: Eliza W
authors.initials: EW
authors.lastname: Beal
authors.affiliation: Department of Radiology, The Ohio State University Wexner Medical Center, James Cancer Hospital , Columbus, OH , USA.
authors.forename: Kristin M
authors.initials: KM
authors.lastname: Dittmar
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, The Ohio State University Wexner Medical Center , Columbus, OH , USA.
authors.forename: A James
authors.initials: AJ
authors.lastname: Hanje
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, The Ohio State University Wexner Medical Center , Columbus, OH , USA.
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Michaels
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, The Ohio State University Wexner Medical Center , Columbus, OH , USA.
authors.forename: Lanla
authors.initials: L
authors.lastname: Conteh
authors.affiliation: Department of Surgery, The Ohio State University Wexner Medical Center, James Cancer Hospital , Columbus, OH , USA.
authors.forename: Gail
authors.initials: G
authors.lastname: Davidson
authors.affiliation: Department of Surgery, The Ohio State University Wexner Medical Center, James Cancer Hospital , Columbus, OH , USA.
authors.forename: Sylvester M
authors.initials: SM
authors.lastname: Black
authors.affiliation: Department of Surgery, The Ohio State University Wexner Medical Center, James Cancer Hospital , Columbus, OH , USA.
authors.forename: P Mark
authors.initials: PM
authors.lastname: Bloomston
authors.affiliation: Department of Surgery, The Ohio State University Wexner Medical Center, James Cancer Hospital , Columbus, OH , USA.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Dillhoff
authors.affiliation: Department of Surgery, The Ohio State University Wexner Medical Center, James Cancer Hospital , Columbus, OH , USA.
authors.forename: Carl R
authors.initials: CR
authors.lastname: Schmidt
keywords: carcinoma; chemoembolization; hepatocellular; liver transplantation; locoregional bridging therapy; microwave ablation; radiofrequency ablation; therapeutic