Background: Liver transplantation remains the only curative treatment option for patients with unresectable hepatocellular carcinoma (HCC). Several bridging treatments are employed because the limited availability of donor organs prolongs waiting time and increases risk of tumor progression. Purpose of our study was to evaluate our experience with the use of (90)Y radioembolization in maintaining potential candidacy for liver transplantation.

Methods: A retrospective review of 34 consecutive patients with HCC who underwent liver transplantation and had been treated with (90)Y radioembolization as a sole modality for locoregional bridging treatment was performed. Demographics, pathologic response, survival, and tumor recurrence were examined.

Results: (90)Y treatments were performed in 34 patients before transplantation in our center since 2007. Median time from first treatment to transplantation was 4.6 months. HCC in 9 patients met the Milan criteria at the time of the first (90)Y treatment and these patients remained within the criteria before transplantation. Complete necrosis of tumor with no evidence of viable tumor on pathologic examination was observed in 13 patients (38%). Partial necrosis was seen in 16 patients (47%). Seven patients developed recurrent HCC. Median time from liver transplantation to tumor recurrence was 13 months.

Conclusion: Particularly in regions with long wait list times (90)Y bridging treatment is effective in maintaining tumor size and achieving tumor necrosis in potential liver transplantation candidates with HCC.

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