Professional paper
Liver transplantation in hepatocellular carcinoma – should we perform downstaging?
Tajana Filipec Kanižaj
orcid.org/0000-0002-9828-8916
; Department of Gastroenterology, Merkur University Hospital, University of Zagreb, School of Medicine, Zagreb, Croatia
Petra Dinjar Kujundžić
; Department of Gastroenterology, Merkur University Hospital, Zagreb, Croatia
Ana Ostojić
; Department of Gastroenterology, University Hospital Center Zagreb, University of Zagreb, School of Medicine, Zagreb, Croatia
Maja Mijić
; Department of Gastroenterology, Merkur University Hospital, Zagreb, Croatia
Helga Sertić Milić
; Clinical Department of Diagnostic and Interventional Radiology, Merkur University Hospital, Zagreb, Croatia
Ana Mijić
; Department of Radiology, University Hospital Center Zagreb, Zagreb, Croatia
Matija Mateljak
; University of Zagreb, School of Medicine, Zagreb, Croatia
Dora Martinčević
; Department of Ophthalmology, Sveti Duh University Hospital, Zagreb, Croatia
Eva Radetić
; Department of Ophthalmology, Sveti Duh University Hospital, Zagreb, Croatia
Vinko Vidjak
orcid.org/0000-0003-3929-3130
; Clinical Department of Diagnostic and Interventional Radiology, Merkur University Hospital, University of Zagreb, School of Medicine, Zagreb, Croatia
Branislav Kocman
; Department of Surgery, Transplant Center, Merkur University Hospital, Zagreb, Croatia
Ivana Mikolašević
; Department of Gastroenterology, Clinical Hospital Centre Rijeka, School of Medicine, University of Rijeka, Rijeka, Croatia
Abstract
Aim To compare the long-term outcomes between liver
transplant (LT) recipients with hepatocellular carcinoma
(HCC) who were downstaged with transarterial-chemoem
-
bolization (TACE) to the Milan criteria (MC) and those ini
-
tially meeting the MC.
Methods This retrospective study enrolled 198 patients
with HCC: 38 were downstaged and 160 patients initially
met the MC. Post-LT survival and HCC recurrence-free sur
-
vival were evaluated. We assessed the association of death
and HCC recurrence with TACE, baseline (age, sex, disease
etiology, Model of End-stage Liver Disease, tumor number
and the sum of maximum tumor diameters, waiting time,
alpha-fetoprotein level) and explant characteristics (tumor
number and the sum of maximum tumor diameters, mi
-
cro- and macrovascular invasion).
Results The recipient survival rates one, three, and five
years after LT were 88.2%, 80.1%, and 75.9%, respectively.
HCC recurrence-free probabilities were 92.3%, 87.9%, and
85%, respectively. The outcomes were comparable be
-
tween the groups. In multivariate analysis, the number of
tumors on the explant, age, and tumor recurrence were
independent risk factors for death. Only the sum of max
-
imum tumor diameters on the explant was an indepen
-
dent risk factor for HCC recurrence.
Conclusions Patients successfully downstaged with TACE
to the MC can achieve post-LT recipient and HCC recur
-
rence-free survival comparable with patients initially with
-
in the MC. Good response to TACE as a criterion for LT may
be a method of selecting patients with favorable biological
characteristics
Keywords
Hrčak ID:
306596
URI
Publication date:
25.8.2022.
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