Locoregional Therapy for HCC Patients Prior to Living Donor Liver Transplantation

Abstract Background: Hepatocellular carcinoma occurs in chronic liver disease and cirrhosis. Loco-regional therapies have the potential to bridge patients within Milan criteria and downstage patients to transplantation. Aim of Study: This study aimed to assess the overall survival and HCC recurrence in patients with HCC undergoing living donor liver transplantation with or without locoregional therapies as bridging or downstaging before transplant. Patients and Methods: This study included 60 HCC patients. Patients were classified into 2 independent groups: The locoregional therapy group (26 patients), and the Non-therapy group (34 patients). Pre-operative assessment in the outpatient clinic. Follow-up after transplantation for two years; every three months using alpha-fetoprotein and ultra-sonography. Dynamic contrast CT scan as routine every 6 months for the first year, then every year. Results: In the studied population, the mean age of all patients was (52.5±4.4) years, The recurrence rate was (25%), with (6.7%) of recurrence patients had open RFA, (33.3%) had a resection, (6.7%) had re-transplantation, and (53.3%) had supportive treatment. The mortality rate was (28.3%). We found significant decrease in recurrence rate in locoregional therapy group (11.5%); compared to non-therapy group (35.3%) (p=0.036). The survival probability regarding recur-rence was markedly increased in Locoregional therapy (in 2011); compared to the non-therapy group in survival curves of the 2 groups. Conclusion: Locoregional therapies have been the main-stay for treating intermediate-stage disease, but they are finding special applications for early and advanced disease.