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KMID : 1143920180220010027
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Annals of Hepato-Biliary-Pancreatic Surgery
2018 Volume.22 No. 1 p.27 ~ p.35
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Bridging therapies to liver transplantation for hepatocellular carcinoma: A bridge to nowhere?
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Tan Chun Han Nigel
Yu Yue
Tan Yan Rui Nicholas
Lim Boon Leng Kieron
Iyer Shridhar Ganpathi
Madhavan Krishnakumar
Kow Alfred Wei Chieh
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Abstract
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Backgrounds/Aims: Liver Transplantation (LT) is a recognized treatment for Hepatocellular Carcinoma (HCC). The role of Bridging Therapies (BT) remains controversial.
Methods: From January 2001 to October 2012, 192 patients were referred to the National University Hospital, Singapore for consideration of LT for HCC. Sixty-five patients (33.8%) were found suitable for transplant and were placed on the waitlist. Analysis was performed in these patients.
Results: The most common etiology of HCC was Hepatitis B (n=28, 43.1%). Thirty-six patients (55.4%) received BT. Seventeen patients (47.2%) received TACE only, while 10 patients (27.8%) received radiofrequency ablation (RFA) only. The remaining patients received a combination of transarterial chemoembolization (TACE) and RFA. Baseline tumor and patient characteristics were comparable between the two groups. The overall dropout rate was 44.4% and 31.0% in the BT and non-BT groups, respectively (p=0.269). The dropout rate due to disease progression beyond criteria was 6.9% (n=2) in the non-bridged group and 22.2% (n=8) in the bridged group (p=0.089). Thirty-nine patients (60%) underwent LT, of which all patients who underwent Living Donor LT did not receive BT (n=4, 21.1%, p=0.030). The median time to LT was 180 days (range, 20-558 days) in the non-BT group and 291 days (range, 17-844 days) in the BT group (p=0.214). There was no difference in survival or recurrence between the BT and non-BT groups (p=0.862).
Conclusions: BT does not influence the dropout rate or survival after LT but it should be considered in patients who are on the waitlist for more than 6 months.
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KEYWORD
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Hepatocellular Carcinoma, Bridging, Liver Transplantation
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