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Bridging Locoregional Therapy for Hepatocellular Carcinoma Prior to Liver Transplantation

¹ Division of Transplantation, University of Pittsburgh, Pittsburgh, PA, USA
² Division of Interventional Radiology, University of Pittsburgh, Pittsburgh, PA, USA
³ Division of Surgical Oncology, University of Pittsburgh, Pittsburgh, PA, USA
⁴ UPMC Liver Cancer Center, 3459 Fifth Avenue, Pittsburgh, PA 15213, USA

Correspondence: Address correspondence and reprint requests to: T. Clark Gamblin, MD, MS; E-mail: gambtc{at}upmc.edu

Introduction: The impact of locoregional therapy prior to liver transplantation for hepatocellular carcinoma utilizing either transcatheter arterial chemoembolization (TACE), yttrium-90 (⁹⁰Y), radiofrequency ablation (RFA), or resection prior to orthotopic liver transplantation (OLT) is largely unknown. We sought to examine locoregional therapies and their effect on survival compared with transplantation alone.

Methods: A retrospective review of a prospectively collected database.

Results: 123 patients were included. Patients were analyzed in two groups. Group I consisted of 50 patients that received therapy (20 TACE; 16 ⁹⁰Y; 13 RFA, 3 resections). Group II consisted of 73 patients transplanted without therapy. Median list time was 28 days (range 2–260 days ) in group I, and 24 days (range 1–380 days) in group II. Median time from therapy to OLT was 3.8 months (range 9 days to 68 months). Twelve patients (24%) were successfully downstaged (8 TACE, 2 ⁹⁰Y, 2 RFA/resection). Overall 1-, 3-, and 5-year survival were 81%, 74%, and 74%, respectively. Survival was not statistically significantly different between the two groups (P = 0.53). The 12 patients downstaged did not have a significant difference in survival as compared with the patients who received therapy but did not respond or the patients who were transplanted without therapy (P = 0.76).

Conclusion: Our report addresses locoregional therapy for hepatocellular carcinoma as a bridge to transplant. There was no statistical difference in overall survival between patients treated and those not treated prior to transplant. We provide further evidence that locoregional therapy is a safe tool for patients on the transplant list, does not impact survival, and can downstage selected patients to allow life-saving liver transplantation.

Key Words: Hepatocellular carcinoma • TACE • Yttrium • Liver transplantation • Bridge therapy • Locoregional therapy