Results of hepatocellular carcinoma downstaging through hepatic transarterial chemoembolization in liver transplantation.

Introduction and aim: Liver transplantation plays an important role in treating hepatocellular carcinoma (HCC). However, diagnosis often occurs when the tumor size exceeds Milan criteria. In this context, locoregional treatments are frequently indicated. The aim of this study is to evaluate cirrhotic patients with HCC undergoing transarterial chemoembolization (TACE) for downstaging.

Methods: This retrospective study assessed medical records of patients aged 18 years or older, diagnosed with HCC, who underwent TACE with the aim of downstaging. In the survival analysis, the Kaplan-Meier method was used. P -value <0.05 was considered statistically significant.

Results: One hundred and twenty-three patients were evaluated, of which 44.7% underwent liver transplantation after downstaging. Mortality in these patients was 32.7% and the probability of survival at 1, 2, and 5 years after liver transplantation was, respectively, 80%, 70.8%, and 57%. When comparing with the unsuccessful group, there was a significant difference regarding number of nodules, size of the largest nodule, and response by Modified Response Evaluation Criteria in Solid Tumor. The characteristics of the group undergoing TACE for downstaging and the group undergoing TACE as a bridge to transplantation were also compared, and patients were selected through the propensity score. A more significant number of nodules was observed in patients who underwent downstaging ( P  = 0.014) and they exceeded Milan criteria in the explanted liver more frequently ( P  = 0.007). Survival in the downstaging group and in the bridge group was not different ( P  = 0.342).

Conclusion: Liver transplantation in patients with HCC after successful downstaging proved to be effective, as patients had adequate survival.