title: Does Preoperative Transarterial Chemoembolization for Hepatocellular Carcinoma Increase the Incidence of Hepatic Artery Thrombosis After Living-Donor Liver Transplant?
abstract: OBJECTIVE
  Transarterial chemoembolization is a potential risk factor for hepatic artery damage, which may lead to severe consequences. We aimed to investigate this controversial issue in our population of liver transplant patients with hepatocellular carcinoma.
  
  
  METHODS
  Between March 2006 and December 2016, a total of 262 patients with hepatocellular carcinoma underwent liver transplant at our institution. Of these, 22 (8.4%) had preoperative transarterial chemoembolization. We retrospectively reviewed the data of all patients, comparing those who did and did not undergo transarterial chemoembolization.
  
  
  RESULTS
  The groups were similar in terms of patient sex, mean age, mean alpha-fetoprotein levels, and Milan criteria. The nontransarterial chemoembolization group had a significantly higher mean Model for End-Stage Liver Disease score. Hepatic artery thrombosis after liver transplantation was diagnosed in 6 of 22 patients (27%) in the transarterial chemoembolization group and in 12 of 240 patients (5%) in the nontransarterial chemoembolization group (P = .002). Retransplant was performed in 5 of the 6 patients with hepatic artery thrombosis in the transarterial chemoembolization group and 3 of the 12 patients in the nontransarterial chemoembolization group (P = .04).
  
  
  CONCLUSIONS
  In patients who undergo transarterial chemoembolization before liver transplantation, the incidence of hepatic artery thrombosis and retransplantation is significantly higher than in those who do not undergo this intervention. The tissues should be carefully handled at the time of transplantation to prevent trauma that may cause intimal dissection in the fragile vessels.
authors.affiliation: Inonu University Liver Transplantation Institute, Malatya, Turkey.
authors.forename: Volkan
authors.initials: V
authors.lastname: Ince
authors.forename: Veysel
authors.initials: V
authors.lastname: Ersan
authors.forename: Serdar
authors.initials: S
authors.lastname: Karakas
authors.forename: Koray
authors.initials: K
authors.lastname: Kutluturk
authors.forename: Nese
authors.initials: N
authors.lastname: Karadag
authors.forename: Ramazan
authors.initials: R
authors.lastname: Kutlu
authors.forename: Sezai
authors.initials: S
authors.lastname: Yilmaz
mesh_terms: D000328:Adult; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000601:surgery; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology / Q000473:pathology / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects*; D017024:Chemotherapy, Adjuvant; D005260:Female; D006499:Hepatic Artery / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D015994:Incidence; D008113:Liver Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000628:therapy*; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000009:adverse effects*; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000601:surgery; D016896:Treatment Outcome; D014421:Turkey / Q000453:epidemiology