Impact of pre-operative transarterial embolization on the treatment of hepatocellular carcinoma with liver transplantation.

Abstract

AIM:

To determine the effectiveness of pre-liver transplant (LT) transarterial embolization (TAE) in treating hepatocellular carcinoma (HCC) and the patient categories, which are likely to have a good outcome after LT.

METHODS:

Twenty-nine patients with hepatitis-related cirrhosis and unresectable HCC after LT were studied over a 7-year period. The patients were divided into two groups: group A patients (19/29) received pre-LT TAE, whereas group B (10/29) underwent LT without prior TAE. According to Milan criteria, group A patients were further subdivided into: group A1 (12/19) who met the criteria, and group A2 (7/19) who did not. Patient survivals were compared.

RESULTS:

In the explanted liver, CT images correlated well with pathological specimens showing that TAE induced massive tumor necrosis (>85%) in 63.1% of patients in group A and all 7 patients in group A2 exhibited tumor downgrading that met Milan criteria. The overall 5-year actuarial survival rate was 80.6%. The TAE group had a better survival (84% at 5 years) than the non-TAE (75% at 4 years). The 3-year survival of group A2 (83%) was also higher than that of group A1 (79%). Tumor necrosis >85% was associated with excellent survival of 100% at 3 years, which was significantly better than the others who showed <85% tumor necrosis (57.1% at 3 years) or who did not have TAE (75% at 3 years).

CONCLUSION:

TAE is an effective treatment for HCC before LT. Excellent long-term survival was achieved in patients that did not fit Milan criteria. Our results broadened and redefined the selection policy for LT among patients with HCC. Meticulous pre-LT TAE helps in further reducing the rate of dropout from waiting lists and should be considered for patients with advanced HCC.

• Authors: Yu-Fan Cheng, Tung-Liang Huang, Tai-Yi Chen, Yaw-Sen Chen, Chih-Chi Wang, Sheng-Lung Hsu, Leo Leung-Chit Tsang, Po-Lin Sun, King-Wah Chiu, Bruno Jawan, Hock-Liew Eng, Chao-Long Chen
• Journal: World journal of gastroenterology (World J Gastroenterol) Vol. 11 Issue 10 Pg. 1433-8 (Mar 14 2005) ISSN: 1007-9327 [Print] United States
• PMID: 15770717 (Publication Type: Clinical Trial, Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Carcinoma, Hepatocellular (surgery)
• Embolization, Therapeutic
• Female
• Humans
• Liver Neoplasms (surgery)
• Liver Transplantation
• Male
• Middle Aged
• Preoperative Care