Liver transplantation outcomes after transarterial chemotherapy for hepatocellular carcinoma

Background Transarterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC) awaiting liver transplantation is widespread, although evidence that it improves outcomes is lacking and there exist concerns about morbidity. The impact of TACE on outcomes after transplantation was evaluated in this study. Methods Patients with HCC who had liver transplantation in the UK were identified, and stratified according to whether they received TACE between 2006 and 2016. Cox regression methods were used to estimate hazard ratios (HRs) for death and graft failure after transplantation adjusted for donor and recipient characteristics. Results In total, 385 of 968 patients (39 center dot 8 per cent) received TACE. Five-year patient survival after transplantation was similar in those who had or had not received TACE: 75 center dot 2 (95 per cent c.i. 68 center dot 8 to 80 center dot 5) and 75 center dot 0 (70 center dot 5 to 78 center dot 8) per cent respectively. After adjustment for donor and recipient characteristics, there were no differences in mortality (HR 0 center dot 96, 95 per cent c.i. 0 center dot 67 to 1 center dot 38; P = 0 center dot 821) or graft failure (HR 1 center dot 01, 0 center dot 73 to 1 center dot 40; P = 0 center dot 964). The number of TACE treatments (2 or more versus 1: HR 0 center dot 97, 0 center dot 61 to 1 center dot 55; P = 0 center dot 903) or the time of death after transplantation (within or after 90 days; P = 0 center dot 291) did not alter the outcome. The incidence of hepatic artery thrombosis was low in those who had or had not received TACE (1 center dot 3 and 2 center dot 4 per cent respectively; P = 0 center dot 235). Conclusion TACE delivered to patients with HCC before liver transplant did not affect complications, patient death or graft failure after transplantation.