title: Transarterial chemoembolization prior to liver transplantation for patients with hepatocellular carcinoma: A meta-analysis.
abstract: OBJECTIVE
  A debate exists over whether using preoperative transarterial chemoembolization for patients with hepatocellular carcinoma before liver transplantation. Numerous studies have been investigating on this, but there is still no unanimous conclusion about the effect of preoperative transarterial chemoembolization. We conducted the meta-analysis of all available studies to systematically evaluate the influence of preoperative transarterial chemoembolization on liver transplant.
  
  
  METHODS
  A systematic search was performed by two authors (Si TF. and Guan RY.) through PubMed, Embase, Cochrane, and Science Citation Index Expanded, combined with Manual Retrieval and Cited Reference Search. The searching cut-off date was 2016/07/31, and all the data obtained were statistically analyzed using Review Manager version 5.1 software (Copenhagen, The Nordic Cochrane Center, The Cochrane Collaboration, 2011) recommended by Cochrane Collaboration.
  
  
  RESULTS
  The study showed that there was no difference between the experimental group and the control group on perioperative mortality (RR = 1.10, 95% confidence interval (CI) = [0.49-2.48], P = 0.82) or biliary complications (RR = 0.96, 95%CI = [0.66-1.39], P = 0.83). Preoperative transarterial chemoembolization had no obvious effect on improving overall survival (HR = 1.05, 95%CI = [0.65-1.72], P = 0. 83) but would result in a higher rate of vascular complications (RR = 2.01, 95%CI = [1.23-3.27], P = 0.005) and a reduction of disease free survival (HR = 1.66, 95%CI = [1.02-2.70], P = 0.04). Subgroup analysis also revealed that patients from transarterial chemoembolization group in Asia had a much lower overall survival rate (HR = 2.65, 95%CI = [1.49-4.71], P = 0.0009) compared with the control group.
  
  
  CONCLUSIONS
  Considering the possible adverse impacts on liver transplantation and the variation in sensitivity to transarterial chemoembolization, clinicians should be more cautious when considering transarterial chemoembolization as the bridging therapy for patients in the waiting list.
authors.affiliation: Department of Hepatobiliary Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Tengfei
authors.initials: T
authors.lastname: Si
authors.affiliation: Department of Hepatobiliary Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Yongjun
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Department of Hepatobiliary Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Di
authors.initials: D
authors.lastname: Ma
authors.affiliation: Department of Hepatobiliary Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Xiaoyong
authors.initials: X
authors.lastname: Gong
authors.affiliation: Department of Hepatobiliary Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Ruoyu
authors.initials: R
authors.lastname: Guan
authors.affiliation: Department of Hepatobiliary Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Boyong
authors.initials: B
authors.lastname: Shen
authors.affiliation: Department of Hepatobiliary Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Chenghong
authors.initials: C
authors.lastname: Peng
mesh_terms: D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D016206:Databases, Bibliographic; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000628:therapy*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D016896:Treatment Outcome
keywords: chemoembolization; hepatocellular carcinoma; liver transplantation; meta-analysis; transarterial