Abstract
Background: liver transplantation (LT) has emerged as the optimal treatment for cirrhotic patients with Hepatocellular carcinoma (HCC) because it cures both tumor and underlying cirrhosis. HCC could be downstaged or controlled by various anticancer therapies, which might bring them chance of undergoing a curative treatment such as LT. Aim of the Work: it was to evaluate the outcomes of HCC downstaged patients using transarterial hepatic chemoembolization (TACE) therapy to allow eligibility for liver transplantation. Patients and Methods: the study included all the cirrhotic patients who underwent TACE for downstaging of HCC to become eligible for liver transplantation at the period from 2008 to 2017 in Ain Shams Specialized Hospital. Al the patients underwent TACE to meet the Milan criteria for liver transplantation. Results: the etiology of cirrhosis and HCC in our patients was primarily Hepatitis C virus which is endemic in our country. All the cases were not eligible for liver transplantation because they were out of Milan criteria, therefore all the cases underwent TACE for downstaging of the tumor to be within the Milan criteria to become fit for liver transplantation. After undergoing TACE for downstaging, Patients underwent living donor liver transplantation, then they were followed up for detection of recurrence on the transplanted liver. Four of the twenty seven patients had recurrent HCC (14.8 %). Conclusion: successful down-staging of HCC by TACE can be achieved in the majority of carefully selected patients and is associated with excellent posttransplantation outcome.
Highlights
Hepatitis C virus (HCV) infection is a major public health burden in Egypt, where it bears the highest prevalence rate in the world
The etiology of cirrhosis and hepatocellular carcinoma (HCC) in our patients was primarily Hepatitis C virus which is endemic in our country
Of the twenty seven patients included in the study thirteen patients were out of Milan criteria because they had three HCC lesions yet one of the lesions or more were larger than 3 cm, eleven patients were out of Milan criteria because there were more than three lesions, the remaining three cases were out because They had a single lesion larger than 5 cm
Summary
Hepatitis C virus (HCV) infection is a major public health burden in Egypt, where it bears the highest prevalence rate in the world. Poor patient selection (excessive tumor burden, unknown tumor biology) made initial results of LT for HCC quite dismal[2] It wasn’t until 1996, when Mazzaferroet al.[3] defined tumor criteria for patient selection (single lesion ≤ 5 cm, or up to 3 lesions ≤ 3 cm each in the absence of tumor vascular invasion or evidence of extra-hepatic metastases) associated with comparable outcome to patients undergoing LT without HCC. They revealed 4 year post-LT survival > 75% and post-LT recurrence rate in the order of 8%.
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