Clinical usefulness of transarterial chemoembolization response prior to liver transplantation as predictor of optimal timing for living donor liver transplantation.
10.4174/astr.2018.95.2.111
- Author:
Chan Woo CHO
1
;
Gyu Seong CHOI
;
Jong Man KIM
;
Choon Hyuck David KWON
;
Doo Jin KIM
;
Jae Won JOH
Author Information
1. Department of Surgery, Yeungnam University College of Medicine, Daegu, Korea.
- Publication Type:Original Article
- Keywords:
Chemoembolization;
Liver transplantation;
Hepatocellular carcinoma
- MeSH:
Carcinoma, Hepatocellular;
Humans;
Kaplan-Meier Estimate;
Liver Transplantation*;
Liver*;
Living Donors*;
Multivariate Analysis;
Proportional Hazards Models;
Recurrence;
Retrospective Studies
- From:Annals of Surgical Treatment and Research
2018;95(2):111-120
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: Response to preoperative transarterial chemoembolization (TACE) has been recommended as a biological selection criterion for liver transplantation (LT). The aim of our study was to identify optimal timing of living donor liver transplantation (LDLT) after TACE based on the TACE response. METHODS: We performed a retrospective study to assess recurrence in 128 hepatocellular carcinoma (HCC) patients who underwent LDLT following sequential TACE from January 2002 to March 2015 at a single institute. Cox proportional hazard models and Kaplan-Meier analysis were utilized to estimate HCC recurrence and find optimal timing for LDLT. RESULTS: Seventy-three and 61 patients were divided as the responder and nonresponder, respectively. Multivariate analysis showed independent pre-liver transplantation (pre-LT) predictors of recurrence were larger sized tumor (>3 cm, P = 0.024), nonresponse to TACE (P = 0.031), vascular invasion (P = 0.002), and extrahepatic nodal involvement (P = 0.001). In the 3-month time difference between last pre-LT TACE and LDLT subgroup, TACE responders showed significantly higher adjusted hazard ratio (aHR) of recurrence free survival (aHR, 6.284; P = 0.007), cancer specific survival (aHR, 7.033; P = 0.016), and overall survival (aHR, 7.055; P = 0.005). Moreover, for overall patients and responder groups, the significant time difference between last pre-LT TACE and LDLT was 2 months in the minimum P-value approach. CONCLUSION: In selected patients who showed good response to pre-LT TACE, a shorter time interval between TACE and LDLT may be associated with higher recurrence free survival, cancer specific survival, and overall survival.
