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Liver Transplantation After Transarterial Chemoembolization and Radiotherapy for Hepatocellular Carcinoma with Vascular Invasion

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Purpose

The study aims to analyze the oncologic outcomes of living donor liver transplantation (LDLT) after combined transarterial chemoembolization (TACE) and radiotherapy for hepatocellular carcinoma (HCC) with major vascular invasion.

Methods

We retrospectively reviewed 17 HCC patients with major vascular invasion who underwent LDLT after combined treatment modality between May 2007 and September 2014. The LDLT timing was determined by the surgeons depending on the disease status and liver function. The intrahepatic recurrence-free survival, disease-free survival (DFS), and overall survival (OS) rates were estimated from the date of the LDLT.

Results

The median follow-up period was 24.5 months (range, 6.4–66.0 months) after the LDLT. The interval between the combined treatment and the LDLT was a median of 5 months (range, 0.4–65.3 months). On the explanted liver, total necrosis was shown in five patients (29.4 %). The 1- and 3-year DFS rates were 70.6 and 57.8 %, respectively. The 1- and 3-year OS rates were 87.4 and 60.5 %, respectively. The major pattern of failure was distant metastasis (35.3 %), and intrahepatic recurrence occurred in three patients (17.6 %) who experienced distant metastasis.

Conclusions

In the selected HCC patients with major vascular invasion, LDLT after combined TACE and radiotherapy showed acceptable oncologic outcomes.

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Authors’ Contributions

Conceived and designed the experiments: YJ MHS SMY GWS KHK CSA DBM SH JHP JHK SGL. Performed the experiments: YJ MHS SMY GWS. Analyzed the data: YJ MHS SMY GWS. Contributed reagents/materials/analysis tools: YJ MHS SMY GWS KHK CSA DBM SH JHP JHK SGL. Wrote the paper: YJ MHS SMY GWS JHK SGL

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Author notes

    Authors and Affiliations

    1. Department of Radiation Oncology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea

      Yuri Jeong, Sang Min Yoon, Jin-hong Park & Jong Hoon Kim

    2. Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea

      Min-Ho Shin, Gi-Won Song, Ki-Hun Kim, Chul-Soo Ahn, Deok-Bog Moon, Shin Hwang & Sung-Gyu Lee

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    1. Yuri Jeong
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    2. Min-Ho Shin
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    3. Sang Min Yoon
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    Corresponding authors

    Correspondence to Sang Min Yoon or Gi-Won Song.

    Ethics declarations

    Every case of transplantation was evaluated and approved by the local authorities as well as the Korean Network for Organ Sharing affiliated by the Ministry of Health and Welfare of Korea. This study was approved by the Institutional Review Board of Asan Medical Center, and written informed consent was waived due to the retrospective nature of the study. However, all information was treated as anonymous and securely protected so as to prevent any invasion of privacy.

    Conflict of Interest

    The authors declare that they have no conflict of interest.

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    Additional information

    Yuri Jeong and Min-Ho Shin contributed equally to this work as first authors. Sang Min Yoon and Gi-Won Song contributed equally to this work as corresponding authors.

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    Jeong, Y., Shin, MH., Yoon, S.M. et al. Liver Transplantation After Transarterial Chemoembolization and Radiotherapy for Hepatocellular Carcinoma with Vascular Invasion. J Gastrointest Surg 21, 275–283 (2017). https://doi.org/10.1007/s11605-016-3302-0

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    • DOI: https://doi.org/10.1007/s11605-016-3302-0

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