Background: Locoregional therapies (LRT) have been employed in patients with hepatocellular carcinoma (HCC) to halt tumor progression and prevent waitlist drop out, as well as to downstage those who are initially outside of Milan criteria. Several treatment modalities, including conventional transarterial chemoembolization (cTACE), drug-eluting bead chemoembolization (DEB-TACE), and radiofrequency ablation (RFA) exist, but the optimal therapy to bridge patients to transplantation remains unknown.

Methods: Adults with HCC who had undergone at least one LRT prior to LT at our institution were included. All recipients who were initially outside of Milan criteria were successfully downstaged prior to LT. Patient and per-lesion tumor characteristics were abstracted from the medical record for analysis. To assess tumor viability on explant, we included only lesions targeted during LRT.

Results: Of 95 LT recipients, 50 underwent cTACE, 36 underwent DEB-TACE, 3 underwent radiofrequency ablation, and 6 underwent a combination of the above. A similar percentage of patients in the cTACE and DEB-TACE groups were outside of Milan criteria prior to LRT (38% vs. 31%, p=0.772). On explant pathology, recipients treated with DEB-TACE were less likely to have complete tumor necrosis when compared to those treated with cTACE (OR: 0.08, 95% CI 0.01-0.43, p=0.003). Recipients in the DEB-TACE group experienced a lower one-year recurrence-free survival than cTACE recipients (74% vs. 92%, p=0.023), but there was no difference in one-year overall survival (92% vs. 87%, p=0.280). Participants who were successfully downstaged, regardless of LRT treatment modality, had similar one-year recurrence-free and overall survival compared to those who were within Milan at initial transplant evaluation (83% vs. 84%, p=0.882, and 78% vs. 94%, p=0.124, respectively).

Conclusions: cTACE may be superior to DEB-TACE in achieving recurrence-free survival after LT for HCC. Patients who are downstaged with either modality enjoy similar survival as those within Milan criteria before LRT.

CITATION INFORMATION: Chen M, Philosophe B. Comparison of Locoregional Therapies for Hepatocellular Carcinoma in Liver Transplant Recipients. Am J Transplant. 2017;17 (suppl 3).

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