S0991 Hepatic Artery Complications Post Liver Transplantation in Patients Treated With Pretransplant Transarterial Chemoembolization

Abstract

INTRODUCTION: The use of locoregional therapy, such as transarterial chemoembolization (TACE), minimizes the risk of hepatocellular carcinoma (HCC) progression in patients with cirrhosis listed for liver transplantation (LT). Previous studies have shown the association of TACE with a higher prevalence of hepatic artery stenosis post LT. In this study, we aimed to compare the prevalence of post-operative hepatic artery complications in LT patients with HCC who received TACE pretransplant versus LT patients with HCC without TACE. METHODS: We conducted a retrospective single-center cohort study of all adult patients who underwent LT at our institute between 2013 and 2018. We collected data on the presence of HCC, receipt of TACE, donor and recipient demographics, graft characteristics, and perioperative variables (Tables 1 and 2). The primary outcome was the development of HAT and HAS. Secondary outcomes were graft failure and mortality. We used univariate and multivariate logistic regression to ascertain the odds of binary outcomes relative to the utilization of TACE. Kaplan Meier estimates were used to compare graft survival and overall survival. RESULTS: We included 145 HCC patients with cirrhosis, out of a total of 341 patients who underwent LT. We compared 91 patients (75.9% males, 61.4 years median age) who received pre-LT TACE with 54 patients (70.3% males, 61 years median age) who did not. The prevalence of HAS was 23.1% in the TACE group and 22.1% in the no TACE group (P = 0.9). The prevalence of HAT was 7.69% in the TACE group and 3.70% in the no TACE group (P = 0.25) (Table 3). Although statistically not significant, the rates of complications after endovascular therapy (EVT) for the treatment of HAS, was higher in the TACE group compared to the no TACE group (5.49% vs. 1.85%, P = 0.41). Four complications were noted in the TACE group (hepatic artery dissections in 3, and one case of stent erosion and extravasation). There was no difference in graft failure and overall mortality between the two groups. CONCLUSION: We found that TACE before LT, did not increase the rate of HAS or HAT post LT. However, we noted higher rates of EVT for HAS related complications in the TACE recipient group. The trauma of arterial instrumentation and arterial wall injury from chemotherapeutic agents may make the patients treated with TACE more prone to vascular complications, particularly after EVT for HAS. Further studies are needed to understand the impact of TACE on post LT vascular complications.Table 1Table 2Table 3