Background: Pretransplant liver directed therapy has emerged as standard of care for patients with end stage liver disease complicated by unresectable hepatocellular cancer. The aim of this study was todetermine whether pre-transplant intra-arterial liver directed therapy (LRT) for hepatocellular carcinoma (HCC) increases the risk of hepatic arterial misadventures (the necessity of a conduit or hepatic artery thrombosis) associated with liver transplant (LT).

Methods: 175 HCC patients underwent LRT with either trans-arterial chemoembolization (TACE) or trans-arterial radioembolization (TARE) with yttrium-90 (Y90) prior to LT between 2003 and 2013 (TACE, n = 82; TARE, n = 93). LT candidates were considered for LRT if they had unresectable HCC (determined by a multidisciplinary tumor board) and bilirubin < 3.0 mg/d. Patients with portal vein thrombosis, extrahepatic metastases, and receiving both TACE and TARE were excluded. A matched control cohort of 159 HCC LT patients who did not have pre-transplant intra-arterial LRT was selected. Diseased/injured recipient hepatic arterial (HA) vasculature was noted to be present if (1) the operative report noted poor-quality recipient vasculature necessitating conduit reconstruction and/or (2) if HAT developed up to two weeks post-operatively.

Results: Among the 175 LRT patients (TACE, n=82; TARE, n=93), 8 required conduits (TACE, n=6; TARE, n=2) and 3 developed HAT (TACE, n=2; TARE, n=1). Of the 159 controls, 7 needed conduits (4%) and 3 developed HAT (2%). Two-tailed z-test between the LRT and the control group reveals a Z-Score of -0.0014 and p-value of 1 (no significant difference). Importantly, when TACE was compared to TARE, neither group demonstrated a higher incidence of arterial injury (Z-Score = 1.78, p-value = 0.075).

Conclusion: Although aggressive pretransplant TARE and TACE are both utilized in most liver transplant centers in HCC patients, neither appears to increase the risk of hepatic arterial misadventure during LT when compared to our control group. These encouraging results lay the foundation for future studies to determine which LRT offers optimal tumor control without concern for collateral arterial injury.

CITATION INFORMATION: Kallini J, Gabr A, Salem R, Lewandowski R, Baker T. Pre-Transplant Intra-Arterial Liver Directed Therapy Does Not Increase the Risk of Hepatic Arterial Misadventures in Liver Transplantation. Am J Transplant. 2016;16 (suppl 3).

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