Abstract
BackgroundIt has been shown that local ablative procedures enable downsizing, reduce drop-out from the waiting list and improve prognosis after liver transplantation. It is still unclear whether a response to the local ablative therapy is due to a favorable tumor biology or if a real benefit in tumor stabilization exists, particularly in complete pathological response.MethodData of 163 HCC patients who underwent liver transplantation were extracted from our prospectively maintained registry. We analyzed the tumor load, pre-transplant α-fetoprotein levels, child stage aside the application and success of local ablative therapies as bridging procedures before transplantation.Results87 patients received multiple and/or combined local therapies. In 20 cases, this resulted in a complete remission of the tumor as observed in the explant histology. The other 76 patients underwent no bridging procedure. The observed 5- and 10-year survival rates for patients with bridging were 67% and 47% and without bridging 56% and 46%, respectively. Tumor-related 10-year survival showed a statistically significant difference between both groups (81% versus 59%). In the multivariate analyses bridging, number of lesions and α-fetoprotein level showed an independent statistically significant influence on tumor-related survival in these patients.ConclusionsSuccessful local ablative therapy before liver transplantation is an independent statistically significant factor in long-term tumor-related survival for patients with HCC in cirrhosis and reduces tumor recurrences.
Highlights
Transarterial chemoembolization (TACE), radio frequency ablation (RFA), radioembolization (RE), percutaneous alcohol injection (PEI), microwave ablation, irreversible electroporation and stereotactic body radiation therapy (SBRT) in combination with thyrosinkinase inhibitor are being employed for local ablative treatment prior to liver transplantation (LT) in selected patients [1–7]
It is still unclear whether a response to the local ablative therapy is due to a favorable tumor biology or if a real benefit in tumor stabilization exists, in complete pathological response
This was most frequently observed in single lesions (13/42 = 31% vs. 7/45 = 16%) and after RFA (5/10 vs. 15/77 = 20%), respectively
Summary
Transarterial chemoembolization (TACE), radio frequency ablation (RFA), radioembolization (RE), percutaneous alcohol injection (PEI), microwave ablation, irreversible electroporation and stereotactic body radiation therapy (SBRT) in combination with thyrosinkinase inhibitor are being employed for local ablative treatment prior to liver transplantation (LT) in selected patients [1–7]. A statistically significant improvement of survival has been documented in a multi-center study of the European Liver Transplant Registry (Pommergard 2018) It is still unclear whether a response to the local ablative therapy is due to a favorable tumor biology or if a real benefit in tumor stabilization exists, in complete pathological response. It has been shown that local ablative procedures enable downsizing, reduce drop-out from the waiting list and improve prognosis after liver transplantation Conclusions Successful local ablative therapy before liver transplantation is an independent statistically significant factor in long-term tumor-related survival for patients with HCC in cirrhosis and reduces tumor recurrences
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
