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Impact of Transarterial Therapy in Hepatitis C-Related Hepatocellular Carcinoma on Long-term Outcomes After Liver Transplantation

Cabrera, Roniel, MD, MS*; Dhanasekaran, Renumathy, MD*; Caridi, James, MD; Clark, Virgina, MD, MS*; Morelli, Giuseppe, MD*; Soldevila-Pico, Consuelo, MD*; Magglioca, Joseph, MD; Nelson, David, MD*; Firpi, Roberto Jose, MD, MS*

American Journal of Clinical Oncology: August 2012 - Volume 35 - Issue 4 - p 345–350
doi: 10.1097/COC.0b013e31821631f6
Original Articles: Gastrointestinal
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Objectives To evaluate the impact of long-term outcomes of transarterial embolization (TAE) therapy in patients with hepatitis C virus (HCV)-related hepatocellular carcinoma (HCC) on the waiting list for liver transplantation (LT).

Methods We retrospectively evaluated the post-LT patients with HCV-related HCC who received TAE intervention (n=33) and those who had no treatment (n=47) while on the waiting list to determine long-term outcomes.

Results Over a 10-year period, of the 424 patients transplanted with HCV, 80 patients had HCC with a tumor burden within Milan criteria. For the entire study cohort, the mean duration of post-LT follow-up was 3.5 years; mean time of transplant waiting list was 120 days; and median post-LT survival was 8.9 years. The survival rates at 1, 3, 5, and 10 years were 82%, 70%, 55%, and 35%, respectively. From the study cohort, 33 patients received TAE and 47 patients did not while on the waiting list. The 2 groups were well matched, except, that the intervention patients received post-LT interferon more often and had a shorter time on the waiting list (56.2 d) when compared with the no treatment group (164.6 d, P<0.001). Median survival in the TAE group was 4.8 years and 8.9 years in the no treatment group. The recurrence rate was 15.6% in the treatment group and 6.9% in the no therapy group (P=0.275).

Conclusions Pre-LT transarterial therapy has no benefit on post-LT survival and tumor recurrence in patients with HCV-related HCC who underwent a mean waiting period of <3 months to transplant.

*Department of Medicine, Division of Gastroenterology and Hepatology Section of Hepatobiliary Diseases and Liver Transplantation

Departments of †Radiology

Surgery, University of Florida, Gainesville, FL

Supported by the NIH KL2 clinical translational science scholar award, Bankhead-Coley new investigator cancer research award and the NIH LRP (RC).

The authors declare no conflicts of interest.

Reprints: Roniel Cabrera, MD, MS, University of Florida, Section of Hepatobiliary Diseases and Liver Transplantation, Division of Gastroenterology and Hepatology, Department of Medicine, 1600 SW Archer Rd, Room M440 MSB, PO Box 100214, JHMHC, Gainesville, FL 32610. e-mail: cabrer@medicine.ufl.edu.

© 2012 by Lippincott Williams & Wilkins, Inc