Response to chemoembolization for hepatocellular carcinoma post liver transplantation: evaluation of the explant

Abstract

Introduction: Liver transplantation is used in the treatment of hepatocellular carcinoma in cirrhotic patients who meet the Milan criteria with appropriate results. The chemoembolization is used as gold standard for downstaging in patients who present with lesions at diagnosis outside the criteria for liver transplantation. Purpose: Our objective was to evaluate the tumor response in patients undergoing chemoembolization in the pre-liver transplantation by analysis of explanted liver after realization. Methods: We evaluated 17 patients who underwent orthotopic liver transplantation between June 2009 and December 2012 by hepatocellular carcinoma who had prior treatment by chemoembolization with doxorubicin at the Hospital of Unicamp. Patients with infiltrative lesion, hypovascular or not tumor portal vein thrombosis were excluded. Response to treatment was evaluated by multislice computed tomography. The average realization of downstaging transplantation was 3,38 months. Results: Analysis of explanted liver tumor necrosis showed less than 25% in 3 patients, 25-50% in 2 patients, 50-90% 3 patients and more than 90% in 9 patients. The average survival was 75% at one year, 64% at 3 years and 47% at 5 years. There was no recurrence in the study group. The microvascular impairment in the evaluation of residual lesions on the explanted liver was seen in 17.64% of cases. Conclusion: chemoembolization is a procedure used in cirrhotic patients with hepatocellular carcinoma for purposes of downstaging and to meet the Milan criteria for orthotopic liver transplantation presented satisfactory response inducing tumor necrosis and no evidence of recurrence in the long term after transplantation.