Impact of multiple sessions of transarterial chemoembolization for hepatocellular carcinoma patients awaiting liver transplantation

Objective To assess the impact of multiple sessions of transarterial chemoembolization (TACE) on tumor necrosis, tumor recurrence and survival in patients awaiting liver transplantation (LT). Methods From January 2003 to December 2012, retrospective analysis was performed for 84 LT patients receiving TACE for HCC. The median follow-up period was 76(0-146) months. Results Among them, 9/84 LT patients (10.7%) developed recurrent HCC. Recurrence had a significant relationship with a short interval between the diagnosis of HCC and LT (<6 months) [P=0.029, odds ratio (OR)=19.2]. No significant relationship existed between tumor necrosis in explant and recurrence. The mean overall survival was 102.8 months (95% confidence interval 594.9-110.8 months) and the 1/3/5-year survival rates were 91.7%, 88.1% and 82.1% respectively. Waiting time <6 months, microvascular invasion and tumor characteristics were statistically associated with shorter survival. The session number of TACE was not associated with tumor necrosis or survival. Conclusions Multiple sessions of TACE are not associated with a higher risk of recurrence or shorter survival. A shorter waiting time before LT is correlated with an elevated risk of recurrence and lowered survival after LT for HCC. Key words: Transarterial chemoembolization (TACE); Hepatocellular carcinoma; Liver transplantation