3:45 PM Abstract No. 276 Can pretransplant TACE improve overall posttransplant survival for patients with hepatocellular carcinoma?

To evaluate the effect of pretransplant transarterial chemoembolization (TACE) on the post-transplant survival of patients with cirrhosis and hepatocellular carcinoma (HCC) undergoing liver transplantation. A retrospective review of all patients with cirrhosis and HCC who underwent liver transplantation from 2/2005 through 7/2015 at a single tertiary care hospital (n = 155; age: 59 ± 4y, male: 76%) was performed. Survival rates were compared using using 2-sample t-tests and multivariate Cox regression. Patients were stratified according to the following variables pre- and post-transplantation (explant): tumor size, alpha-fetoprotein (AFP) level, liver function tests, and the Model for End-stage Liver Disease (MELD) score. Of 155 patients who underwent liver transplantation for HCC, 136 (88%) met Milan criteria at the time of presentation and 19 (12%) were downstaged to the Milan criteria before transplantation. Eighty-seven of 155 (56%) underwent pretransplant TACE (51% conventional TACE, 49% drug-eluting beads TACE). One-, 3-, and 5-year survival rates, respectively, were 84%, 71%, and 63% for all patients; 91%, 78%, and 73% for TACE patients; and 76%, 63%, and 54% for non-TACE patients. The patients treated with TACE prior to transplant had a 44% reduction in post-transplant mortality (Hazard ratio [HR]:0.56, P = 0.04). Poor overall survival was seen in patients with the largest tumor size >3 cm (HR:1.5, P = 0.15); pretransplant AFP >659ng/mL (HR:2.9, P = 0.006); higher MELD score (HR = 1.53, P<0.001). Pretransplant Milan criteria, liver function test values, and European Association for the Study of the Liver imaging response were not correlated with survival. Pretransplant TACE may be associated with better overall survival in patients who undergo a liver transplantation for cirrhosis and HCC. In the present series, there was no significant difference in the post-transplant survival rate between the patients who were within Milan criteria initially and those who were downstaged into Milan criteria after TACE.