Pre-transplant locoregional therapy and post-transplant outcomes in hepatocellular carcinoma: a single-center retrospective cohort study
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background: Pre-transplant locoregional therapy (LRT), most commonly transarterial chemoembolization (TACE) or transarterial radioembolization (TARE), is used as bridging or downstaging treatment in selected patients with hepatocellular carcinoma (HCC) who undergo liver transplantation (LT). Defining post-transplant outcomes after LRT is important for refining selection, counseling, and program-level care. This study aimed to characterize pre-transplant TACE/TARE use, downstaging success, post-transplant outcomes in a single-center HCC transplant cohort. Methods: We conducted a retrospective single-center cohort study of 113 consecutive patients who underwent LT for HCC at King Fahad Specialist Hospital, Dammam, Saudi Arabia, during 2014-2024. Twenty-four patients received TACE and/or TARE before LT and 89 did not. Liver-transplant eligibility was assessed using the Milan criteria: a single tumor ≤5 cm or up to three tumors each ≤3 cm, with no macrovascular invasion or extrahepatic spread. Baseline characteristics and post-transplant outcomes were summarized using available-case denominators. Downstaging was assessed among 14 LRT-treated patients whose tumor burden initially exceeded Milan criteria. Recurrence-free survival (RFS) was estimated with Kaplan-Meier methods and compared using the log-rank test. The study was approved by the Institutional Review Board of King Fahad Specialist Hospital (MOTC0044). Results: 21.8%; P=0.03). Successful downstaging to Milan criteria was documented in 8 of 14 LRT-treated patients (57.1%). RFS curves were closely aligned between groups (log-rank P=0.97). HCC recurrence occurred in 7 of 113 patients (6.2%). Biliary, infectious, and rejection complications occurred in 16/85 (18.8%), 36/88 (40.9%), and 19/88 (21.6%), respectively, using available-case denominators. Conclusions: Pre-transplant TACE/TARE was used selectively in patients with greater tumor burden and achieved documented downstaging to Milan criteria in 57.1% of treated patients beyond criteria. Post-transplant RFS was comparable between groups, while overall recurrence and complication frequencies were low in the cohort. These findings provide a clinically relevant regional benchmark and support prospective evaluation of LRT within standardized transplant pathways.
Language: English
Subfield: Hepatology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7224105981