Effectiveness of Transarterial Embolization of Hepatocellular Carcinoma as a Bridge to Transplantation

Abstract

PurposeTo assess the effectiveness of bland transarterial embolization of hepatocellular carcinoma (HCC) as a “bridge” to transplantation. Materials and MethodsIn this retrospective study, 117 patients with HCC that met Milan criteria underwent bland embolization as their initial and sole therapy for treatment of HCC (88 men and 29 women; mean age, 60.4 y; range, 35–88 y). Subsequent postembolization contrast-enhanced computed tomography or magnetic resonance imaging studies were reviewed to determine whether Milan criteria were met in an intent-to-transplant analysis. Freedom from progression beyond Milan criteria and survival were calculated by Kaplan–Meier technique. Predictors of progression and survival were also assessed. ResultsAfter embolization, 87% and 78% of patients’ disease still met Milan criteria at 6 and 12 months, respectively. The median time until disease progression beyond Milan criteria was 22.6 months (95% confidence interval, 16.2–29 mo). α-Fetoprotein levels, number of lesions, United Network for Organ Sharing stage, Model for End-stage Liver Disease score, and cirrhosis etiology did not correlate significantly with stability within Milan criteria. A total of 34 patients (29%) underwent eventual liver transplantation at a median of 3.3 months (range, 0.5–20.9 mo). Liver transplantation was a significant independent predictor of longer survival (6.9 y vs 2.6 y; P < .001). The major complication rate within 30 days of embolization was 2.6%, including one mortality. ConclusionsBland transarterial embolization as a bridging strategy to maintain HCC within Milan criteria was successful in 78% of patients at 1 year, which compares favorably with other locoregional embolotherapies.