Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Jun 18, 2024; 14(2): 90571
Published online Jun 18, 2024. doi: 10.5500/wjt.v14.i2.90571
Transarterial embolization is an acceptable bridging therapy to hepatocellular carcinoma prior to liver transplantation
Gabriel Lazzarotto-da-Silva, Leandro A Scaffaro, Mauricio Farenzena, Lucas Prediger, Rafaela K Silva, Flávia Heinz Feier, Tomaz J M Grezzana-Filho, Pablo D Rodrigues, Alexandre de Araujo, Mario Reis Alvares-da-Silva, Roberta C Marchiori, Cleber Rosito Pinto Kruel, Marcio Fernandes Chedid
Gabriel Lazzarotto-da-Silva, Lucas Prediger, Rafaela K Silva, Flávia Heinz Feier, Tomaz J M Grezzana-Filho, Pablo D Rodrigues, Cleber Rosito Pinto Kruel, Marcio Fernandes Chedid, Department of Liver Transplant and Hepatobiliary Surgery Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre 90035-007, Brazil
Leandro A Scaffaro, Mauricio Farenzena, Department of Interventional Radiology Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre 90035-007, Brazil
Alexandre de Araujo, Mario Reis Alvares-da-Silva, Roberta C Marchiori, Department of Gastroenterology and Hepatology, Hospital de Clínicas de Porto Alegre, Porto Alegre 90035-007, Brazil
Author contributions: Lazzarotto-da-Silva G and Chedid MF participated in the research design, data collection, data analysis, and writing of the manuscript; Scaffaro LA, Farenzena M, Feier FH, Grezzana-Filho TJM, Rodrigues PD, de Araujo A, Alvares-da-Silva MR, Marchiori RC, and Kruel CRP participated in the research design and revision of the final version of the manuscript; Prediger L and Silva RK participated in data collection and writing of the manuscript.
Supported by Financiamento e Incentivo à Pesquisa (FIPE/HCPA) of Hospital de Clínicas de Porto Alegre, No. 2020-0473.
Institutional review board statement: This study complies with ethical standards and was approved by the Hospital de Clínicas de Porto Alegre Institutional Review Board, No: CAAE 37950720.9.0000.5327.
Informed consent statement: Informed consent was waived by the ethics committee because this was an observational retrospective study.
Conflict-of-interest statement: All authors declare no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Marcio Fernandes Chedid, MD, MSc, PhD, Professor, Department of Liver Transplant and Hepatobiliary Surgery Unit, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2350, Porto Alegre 90035-007, Brazil. mchedid@hcpa.edu.br
Received: December 7, 2023
Revised: February 12, 2024
Accepted: April 3, 2024
Published online: June 18, 2024
Processing time: 189 Days and 21.4 Hours
Abstract
BACKGROUND

Hepatocellular carcinoma (HCC) is an aggressive malignant neoplasm that requires liver transplantation (LT). Despite patients with HCC being prioritized by most organ allocation systems worldwide, they still have to wait for long periods. Locoregional therapies (LRTs) are employed as bridging therapies in patients with HCC awaiting LT. Although largely used in the past, transarterial embolization (TAE) has been replaced by transarterial chemoembolization (TACE). However, the superiority of TACE over TAE has not been consistently shown in the literature.

AIM

To compare the outcomes of TACE and TAE in patients with HCC awaiting LT.

METHODS

All consecutive patients with HCC awaiting LT between 2011 and 2020 at a single center were included. All patients underwent LRT with either TACE or TAE. Some patients also underwent percutaneous ethanol injection (PEI), concomitantly or in different treatment sessions. The choice of LRT for each HCC nodule was determined by a multidisciplinary consensus. The primary outcome was waitlist dropout due to tumor progression, and the secondary outcome was the occurrence of adverse events. In the subset of patients who underwent LT, complete pathological response and post-transplant recurrence-free survival were also assessed.

RESULTS

Twelve (18.5%) patients in the TACE group (only TACE and TACE + PEI; n = 65) and 3 (7.9%) patients in the TAE group (only TAE and TAE + PEI; n = 38) dropped out of the waitlist due to tumor progression (P log-rank test = 0.29). Adverse events occurred in 8 (12.3%) and 2 (5.3%) patients in the TACE and TAE groups, respectively (P = 0.316). Forty-eight (73.8%) of the 65 patients in the TACE group and 29 (76.3%) of the 38 patients in the TAE group underwent LT (P = 0.818). Among these patients, complete pathological response was detected in 7 (14.6%) and 9 (31%) patients in the TACE and TAE groups, respectively (P = 0.145). Post-LT, HCC recurred in 9 (18.8%) and 4 (13.8%) patients in the TACE and TAE groups, respectively (P = 0.756). Posttransplant recurrence-free survival was similar between the groups (P log-rank test = 0.71).

CONCLUSION

Dropout rates and posttransplant recurrence-free survival of TAE were similar to those of TACE in patients with HCC. Our study reinforces the hypothesis that TACE is not superior to TAE as a bridging therapy to LT in patients with HCC.

Keywords: Hepatocellular carcinoma; Transarterial embolization; Transarterial chemoembolization; Liver transplantation; Locoregional therapy; Bridging

Core Tip: Hepatocellular carcinoma (HCC) is an aggressive malignant neoplasm, and the treatment of choice is liver transplantation (LT). Because the waiting time is often unpredictable, locoregional therapy is used to halt HCC progression until an organ is available. Although largely replaced by transarterial chemoembolization (TACE), transarterial embolization (TAE) or bland embolization is an alternative with a lower cost and safer adverse event profile. Our findings, in conjunction with those of previous studies, provide evidence of non-superiority of TACE over TAE, thereby encouraging a more liberal use of TAE for bridging HCC to LT.