Microwave Ablation as Bridging to Liver Transplant for Patients with Hepatocellular Carcinoma: A Single-Center Retrospective Analysis. J Vasc Interv Radiol 2022 Sep;33(9):1045-1053
Date
06/07/2022Pubmed ID
35667580DOI
10.1016/j.jvir.2022.05.019Scopus ID
2-s2.0-85134606304 (requires institutional sign-in at Scopus site) 5 CitationsAbstract
PURPOSE: To evaluate the efficacy and safety of microwave (MW) ablation as first-line locoregional therapy (LRT) for bridging patients with hepatocellular carcinoma (HCC) to liver transplant.
MATERIALS AND METHODS: This retrospective study evaluated 88 patients who received percutaneous MW ablation for 141 tumors as first-line LRT for HCC and who were listed for liver transplantation at a single medical center between 2011 and 2019. The overall survival (OS) rate statuses after liver transplant, waitlist retention, and disease progression were evaluated using the Kaplan-Meier techniques.
RESULTS: Among the 88 patients (72 men and 16 women; mean age, 60 years; Model for End-Stage Liver Disease score, 11.2) who were listed for transplant, the median waitlist time was 9.4 months (interquartile range, 5.5-18.9). Seventy-one (80.7%) patients received transplant after a median waitlist time of 8.5 months. Seventeen (19.3%) patients were removed from the waitlist; of these, 4 (4.5%) were removed because of tumors outside of the Milan criteria (HCC-specific dropout). No difference in tumor size or alpha-fetoprotein was observed in the transplanted versus nontransplanted patients at the time of ablation (2.1 vs 2.1 cm and 34.4 vs 34.7 ng/mL for transplanted vs nontransplanted, respectively; P > .05). Five (5.1%) of the 88 patients experienced adverse events after ablation; however, they all recovered. There were no cases of tract seeding. The local tumor progression (LTP) rate was 7.2%. The OS status after liver transplant at 5 years was 76.7%, and the disease-specific survival after LTP was 89.6%, with a median follow-up of 61 months for all patients.
CONCLUSIONS: MW ablation appears to be safe and effective for bridging patients with HCC to liver transplant without waitlist removal from seeding, adverse events, or LTP.
Author List
Couillard AB, Knott EA, Zlevor AM, Mezrich JD, Cristescu MM, Agarwal P, Ziemlewicz TJ, Longhurst C, Lubner MG, Hinshaw JL, Said A, Laeseke PF, Lucey MR, Rice JP, Foley D, Al-Adra D, Lee FT JrAuthor
Mircea M. Cristescu MD Assistant Professor in the Radiology department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Carcinoma, HepatocellularCatheter Ablation
End Stage Liver Disease
Female
Humans
Liver Neoplasms
Liver Transplantation
Male
Microwaves
Middle Aged
Retrospective Studies
Severity of Illness Index
Treatment Outcome
