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Excerpt
Backgrouds/aims: Liver transplantation (LT) is one of the best therapeutic options in patients with small hepatocellular carcinomas (HCCs). When liver transplantation has been decided, the time necessary for obtaining a graft is quite variable. In order to prevent the risk of progression of the tumor while waiting for a graft, the use of percutaneous treatments has been suggested. These treatments include arterial chemoembolisation (CE), alcoholisation (ALC) and radiofrequency (RF). The aims of this study were to assess the morphologic efficacy of these treatments and their influence on recurrence and survival after liver transplantation in a series of patients transplanted for HCC.
Patients: From 1989 to 1998, 42 consecutive patients (29 males and 13 females) were included in this study. Mean age was 48±13 years. Four groups were considered according to pre-LT treatment: (1) no treatment, (2) CE, (3) ALC or RF and (4) CE and ALC. Mean time interval from inscription on the waiting list to transplantation was 3.7 months. Mean follow up post-transplantation was 21 months. The extent of necrosis of liver nodules after percutaneous treatment was assessed on the resected liver.
Results:(Table)
Conclusions: The results observed in this series show that: (a) tumor necrosis was significantly less frequent in patients who did not receive percutaneous treatment before LT, (b) complete tumor necrosis was significantly more frequent in patients who had ALC or RF and (c) the incidence of recurrence of HCC was significantly lower in patients who had pre-LT ALC or RF as compared with CE. These results suggest that patients with HCC who are waiting for LT should be treated preferentially by ALC or RF.
