Bridging therapies to liver transplantation for hepatocellular carcinoma: A bridge to nowhere?

Chun Han Nigel Tan; Yue Yu; Yan Rui Nicholas Tan; Boon Leng Kieron Lim; Shridhar Ganpathi Iyer; Krishnakumar Madhavan; Alfred Wei Chieh Kow

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저자정보: Chun Han Nigel Tan (National University Health System) Yue Yu (National University of Singapore) Yan Rui Nicholas Tan (National University of Singapore) Boon Leng Kieron Lim (National University Health System) Shridhar Ganpathi Iyer (National University Health System) Krishnakumar Madhavan (National University Health System) Alfred Wei Chieh Kow (National University Health System)

저널정보: 한국간담췌외과학회 Annals of Hepato-Biliary-Pancreatic Surgery 한국간담췌외과학회지 제22권 제1호

발행연도: 2018.2

수록면: 27 - 35 (9page)

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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.

#Hepatocellular Carcinoma #Bridging #Liver Transplantation

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