Ann Hepatobiliary Pancreat Surg.  2018 Feb;22(1):27-35. 10.14701/ahbps.2018.22.1.27.

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

• Tan CH
• Yu Y
• Tan YR
• Lim BL
• Iyer SG
• Madhavan K
• Kow AW

• KMID: 2409077
• DOI: http://doi.org/10.14701/ahbps.2018.22.1.27

Abstract

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.

Keyword

Hepatocellular Carcinoma; Bridging; Liver Transplantation

MeSH Terms

Carcinoma, Hepatocellular*
Catheter Ablation
Disease Progression
Hepatitis B
Humans
Liver Transplantation*
Liver*
Living Donors
Recurrence
Singapore

Figure

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  Fig. 1 Flowchart for referrals to NUH for consideration of LT for HCC.

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  Fig. 2 Comparison of Overall Survival (OS) after liver transplantation between BT and Non-BT groups.

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  Fig. 3 Comparison of Disease Free Survival (DFS) after liver transplantation between BT and Non-BT groups.

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