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Mentions: The characteristics of r-HCC are summarized in Table 2. The median time from liver transplantation to detection of r-HCC was 15 months (range, 2-57 months). TACE was performed within one year, between one and three years, between two and three years, or more than three years after LDLT in 16 (57.1%), seven (25.0%), four (14.3%), or one (3.6%) patient, respectively. Nine of 26 patients with intrahepatic recurrence had solitary nodular r-HCC (Fig. 1), while the remaining 17 patients had multiple r-HCC (Fig. 2). Eighteen study patients (64.3%) were initially diagnosed with r-HCC extrahepatic metastasis, of which lung metastasis was the most common followed by bone and peritoneal metastases (Table 2). AFP values were greater than 400 ng/ml in 18 of 28 patients (64.3%).
Tumor Response to Transcatheter Arterial Chemoembolization in Recurrent Hepatocellular Carcinoma after Living Donor Liver Transplantation
Bottom Line: The 1-, 3- and 5-year survival rates following TACE were 47.9, 6.0 and 0%, respectively, with a mean survival of nine months in all patients.There were no significant complications related to TACE.However, the survival rate of patients with r-HCC after LDLT is poor due to extrahepatic metastasis and intrahepatic recurrence.
Affiliation: Department of Radiology, Severance Hospital, University of Yonsei College of Medicine, Seoul 120-752, Korea. email@example.com
Objective: To evaluate the tumor response and patient survival rate following transcatheter arterial chemoembolization (TACE) in recurrent hepatocellular carcinoma (r-HCC) after living donor liver transplantation (LDLT).
Materials and methods: Twenty-eight patients with r-HCC underwent one or more cycles of TACE after LDLT (mean, 2.5 cycles). After a mixture of iodized oil and anti-cancer drugs was injected via the arteries feeding the tumors, these vessels were embolized with a gelatin sponge. Tumor response was determined by follow-up CT imaging on all patients four weeks after each TACE procedure. Patient survival was calculated using the Kaplan-Meier survival curve.
Results: After TACE, targeted tumor reduced in size by 25% or more in 19 of the 28 study patients (67.9%). However, intrahepatic recurrence or extrahepatic metastasis occurred in 21 of the 28 patients (75.0%) during the 3-month follow-up period and in 26 of the 28 patients (92.9%) during the 6-month period following TACE. Extrahepatic metastasis was noted in 18 of the 28 patients (64.3%). The 1-, 3- and 5-year survival rates following TACE were 47.9, 6.0 and 0%, respectively, with a mean survival of nine months in all patients. There were no significant complications related to TACE.
Conclusion: TACE produces an effective tumor response for targeted r-HCC after LDLT. However, the survival rate of patients with r-HCC after LDLT is poor due to extrahepatic metastasis and intrahepatic recurrence.
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