title: Yttrium-90 Radioembolization for Hepatocellular Carcinoma Prior to Liver Transplantation.
abstract: Liver transplantation (LT) is a well-established procedure for hepatocellular carcinoma (HCC) within the Milan criteria. Yttrium-90 microspheres radioembolization (Y90-RE) has shown to be an effective and safe treatment of primary liver tumors. We retrospectively evaluate the efficacy of the Y90-RE in patients with HCC prior to LT.
  
  
  
  From January 2002 to December 2015, 365 patients were transplanted at the San Camillo Hospital Center. One hundred forty-three patients were transplanted for HCC, and in 22 cases the patients were treated with Y90-RE before LT.
  
  
  
  Three patients were treated with Y90-RE within the Milan criteria, and 19 patients were out of criteria before Y90-RE. Four patients had an increasing MELD score between Y90-RE and LT. On the other hand, alpha-fetoprotein decreases after Y90-RE treatment in all cases. No patient death was observed in Y90-RE procedure or at LT. In 78.9 % of cases, a successful downstaging was observed, and in 100 % of cases bridging was achieved. From Y90-RE treatment overall survival was 43.9 months. From LT, overall mean survival was 30.2 months with a free survival of 29.6 months. The overall survival after LT analysis between the patients treated with Y90-RE and patients without was not significant (p = 0.113). Free survival analysis was not significant (p = 0.897) between the two populations.
  
  
  
  We successfully performed LT in patients after Y90-RE treatment both as bridging and downstaging for HCC and obtained a similar overall and free survival of LT for HCC within Milan criteria. Y90-RE becomes a real option to provide curative therapy for patients who traditionally are not considered eligible for surgery.
authors: Division of General Surgery and Liver Transplantation, San Camillo Hospital, circ.ne Gianicolense 87, 00152, Rome, Italy. gmettorre@scamilloforlanini.rm.it.
authors: Giuseppe Maria
authors: GM
authors: Ettorre
authors: Division of General Surgery and Liver Transplantation, San Camillo Hospital, circ.ne Gianicolense 87, 00152, Rome, Italy. gblevisandri@gmail.com.
authors: Giovanni Battista
authors: GB
authors: Levi Sandri
authors: Division of General Surgery and Liver Transplantation, San Camillo Hospital, circ.ne Gianicolense 87, 00152, Rome, Italy.
authors: Andrea
authors: A
authors: Laurenzi
authors: Division of General Surgery and Liver Transplantation, San Camillo Hospital, circ.ne Gianicolense 87, 00152, Rome, Italy.
authors: Marco
authors: M
authors: Colasanti
authors: Division of General Surgery and Liver Transplantation, San Camillo Hospital, circ.ne Gianicolense 87, 00152, Rome, Italy.
authors: Roberto Luca
authors: RL
authors: Meniconi
authors: Division of Hepatology and Infectious Disease, National Institute for Infectious Disease "L. Spallanzani", via Portuense 292, 00152, Rome, Italy.
authors: Raffaella
authors: R
authors: Lionetti
authors: Division of General Surgery and Liver Transplantation, San Camillo Hospital, circ.ne Gianicolense 87, 00152, Rome, Italy.
authors: Roberto
authors: R
authors: Santoro
authors: Division of General Surgery and Liver Transplantation, San Camillo Hospital, circ.ne Gianicolense 87, 00152, Rome, Italy.
authors: Pasquale
authors: P
authors: Lepiane
authors: Division of Nuclear Medicine, IFO Regina Elena National Cancer Institute, via Elio Chianesi 53, 00100, Rome, Italy.
authors: Rosa
authors: R
authors: Sciuto
authors: Division of Interventional Radiology, IFO Regina Elena National Cancer Institute, via Elio Chianesi 53, 00100, Rome, Italy.
authors: Giuseppe
authors: G
authors: Pizzi
authors: Division of Interventional Radiology, S.M. Goretti Hospital, via Guido Reni, 04010, Latina, Italy.
authors: Roberto
authors: R
authors: Cianni
authors: Division of Radiology, S. Orsola-Malpighi Hospital, via Pietro Albertoni 15, 40138, Bologna, Italy.
authors: Rita
authors: R
authors: Golfieri
authors: Division of Hepatology and Infectious Disease, National Institute for Infectious Disease "L. Spallanzani", via Portuense 292, 00152, Rome, Italy.
authors: Gianpiero
authors: G
authors: D'Offizi
authors: Liver Unit, San Camillo Forlanini Hospital, circ.ne Gianicolense 87, 00152, Rome, Italy.
authors: Adriano M
authors: AM
authors: Pellicelli
authors: Anesthesiology and Intensive Care Unit, National Institute for Infectious Disease "L. Spallanzani", Rome, Italy.
authors: Mario
authors: M
authors: Antonini
authors: Division of General Surgery and Liver Transplantation, San Camillo Hospital, circ.ne Gianicolense 87, 00152, Rome, Italy.
authors: Giovanni
authors: G
authors: Vennarecci
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000628:therapy; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality* / Q000628:therapy*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D019275:Radiopharmaceuticals / Q000627:therapeutic use*; D012189:Retrospective Studies; D015021:Yttrium Radioisotopes / Q000627:therapeutic use*
chemical_list: D019275:Radiopharmaceuticals; D015021:Yttrium Radioisotopes