Long-Term Outcome of Liver Transplantation for Hepatocellular Carcinoma After Bridging or Downstaging with Doxorubicin-Eluting Superabsorbent Polymer Microspheres.

PURPOSE

To retrospectively evaluate the long-term outcomes of patients treated with liver transplantation after neoadjuvant or induction transarterial chemoembolization using doxorubicin-eluting superabsorbent polymer microspheres and to assess risk factors associated with disease recurrence and death after transplantation.

MATERIALS AND METHODS

Between January 2006 and April 2021, 286 patients underwent liver transplantation related to cirrhosis and early hepatocellular carcinoma (HCC). Demographic, angiographic imaging, and clinical follow-up data were collected from patients' electronic medical records. Kaplan-Meier method was used to estimate disease-free survival. The prognostic effect of patient and disease characteristics on HCC recurrence was analyzed using logistic regression models.

RESULTS

Fifty-three out of 286 patients (19%) underwent neoadjuvant or induction chemoembolization with doxorubicin-eluting superabsorbent polymer microspheres as bridging (n = 36) or as downstaging (n = 17) treatment. Time between diagnosis and liver transplantation was 311 days (range:225-440). Post-transplant follow-up revealed HCC recurrence in n = 1 (3%) and n = 4 (23.5%) patients in the bridging and downstaging groups, respectively, and disease-free survival at 5 years of 86% and 65% (p < 0.05) in the bridging and downstaging groups, respectively. Prognostic factors for post-transplant HCC recurrence include number of HCC lesions (p = 0.0088) and total tumor size (p = 0.0188) at diagnosis, as well as number of lesions (p = 0.0181) and largest tumor size (p = 0.0179) at explant analysis.

CONCLUSION

Neoadjuvant or induction chemoembolization with doxorubicin-eluting superabsorbent polymer microspheres is associated with a low incidence of post-transplant HCC recurrence; number and total size of HCC lesions at diagnosis and at explant analysis are risk factors for post-transplant HCC recurrence.