engleski

Transarterial Chemoembolization Prior to Liver Transplantation in Patients with Hepatocellular Carcinoma - a single-center experience.

Introduction: Liver transplantation (LT) is a curative treatment option for patients with heaptocellular carcinoma (HCC) and liver cirrhosis. Aims: The aim of this study is to present our results using transarterial chemoembolization (TACE) in HCC patients before LT. Material and Methods: A retrospective analysis was performed on data of patients with HCC who were treated with at least one TACE followed by LT between 2010 and the end of 2016. Demographic, etiological, laboratory and histological characteristics, as well as waiting time (WT) on list for LT were reviewed. Results: In total period 197 patients with HCC underwent LT. Among them 28 patients with HCC were treated with TACE prior to LT. Because of insufficient data, 25 patients were included in this study. Majority of patients were male (76%), the mean age at the time of LT was 61±5.3 years with the mean body mass index (BMI) of 28±4, 38 kg/m2 . Leading etiology of liver disease was alcohol (60%), followed by viral hepatitis (24%). 96% patients were classified in stage A or B according to the Barcelona Clinical Liver Cancer classification. The median of a serum α- fetoprotein concentration was 14.30 (1.30- 13527.0) µg/L with the mean MELD score 12±4 before LT. In 60% patients one cycle of TACE was preformed while the rest of study patients undergone 2 or more cycles. The median of WT on the list was 16 (1- 354) days. Before entering the pre-transplant TACE protocol, 7 patients assumed to meet and 18 to exceed the Milan criteria. According to the surgical specimens (SS), 11 patients met and 14 exceeded the MC. On the histopathological examination the median number of tumor lesions were (1-11) with sum of lesions 72 (10-300) mm. Vessel microinvasion was observed in 52, 8% and macroinvasion in 8% patients. After a median follow up of 21 (3-74) months overall survival is 88%. 4 patients developed recurrent HCC after LT. There was no statistical significant difference between survival and HCC recurrence in patients in and out of MC according to SS (p=0.39 and P=0.79 respectively). Conclusions: Even though TACE was performed with intention to downstage or as a bridge therapy before LT, more than 50% patients exceed MC after TACE. Nevertheless, there was no significant difference in survival nor HCC recurrence when comparing them to patients who meet MC. Current high donor rate in Croatia provides HCC patients short WT on the list for LT.

hepatocellular carcinoma ; transarterial chemoembolization ; liver transplantation ;

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