TY - JOUR
T1 - Liver Transplantation Following Yttrium-90 Radioembolization
T2 - 15-year Experience in 207-Patient Cohort
AU - Gabr, Ahmed
AU - Kulik, Laura
AU - Mouli, Samdeep
AU - Riaz, Ahsun
AU - Ali, Rehan
AU - Desai, Kush
AU - Mora, Ronald A
AU - Ganger, Daniel
AU - Maddur, Haripriya
AU - Flamm, Steven
AU - Boike, Justin
AU - Moore, Christopher
AU - Thornburg, Bartley
AU - Alasadi, Ali
AU - Baker, Talia
AU - Borja-Cacho, Daniel
AU - Katariya, Nitin
AU - Ladner, Daniela P
AU - Caicedo, Juan Carlos
AU - Lewandowski, Robert J
AU - Salem, Riad
N1 - This article is protected by copyright. All rights reserved.
PY - 2020/5/16
Y1 - 2020/5/16
N2 - Radioembolization (Y90) is used in hepatocellular carcinoma (HCC) as a bridging as well as downstaging liver directed therapy to curative liver transplantation. In this study we report long-term outcomes of liver transplantation (LT) for HCC patients bridged/downstaged by Y90. Patients undergoing LT following Y90 between 2004-2018 were included, with staging by United Network of Organ Sharing (UNOS) TNM at baseline pre-Y90 and pre-LT. Post-Y90 toxicities were recorded. Histopathological data of HCC at explant were recorded. Long-term outcomes including overall survival (OS), recurrence-free survival (RFS), disease-specific mortality (DSM) and time-to-recurrence (TTR) were reported. Time-to-endpoint analyses were estimated using Kaplan-Meier. Uni/multivariate analyses were performed using log-rank test and Cox proportional hazards model, respectively. During the 15-year period, 207 patients underwent LT after Y90. OS from LT was 12.5 years, with median time to LT of 7.5 months (IQR: 4.4-10.3). 169 patients were bridged while 38 were downstaged to LT. 94 (45%), 60 (29%) and 53 (26%) patients showed complete, extensive and partial tumor necrosis on histopathology. Three, five and ten-year OS rates were 84%, 77%, and 60% respectively. Twenty-four patients developed recurrence, with median RFS of 120 (95%CI: 69-150) months. DSM at 3, 5 and 10 years was 6%, 11% and 16% respectively. There were no differences in OS/RFS for bridged or downstaged patients. RFS was higher in patients with complete/extensive versus partial tumor necrosis (p<0.0001). For UNOS T2 patients treated during the study period, 5.2% dropped out due disease progression. Conclusion: Y90 is an effective treatment for HCC in the setting of bridging/downstaging to LT. Patients who achieved extensive or complete necrosis had better RFS, supporting the practice of neoadjuvant treatment prior to LT.
AB - Radioembolization (Y90) is used in hepatocellular carcinoma (HCC) as a bridging as well as downstaging liver directed therapy to curative liver transplantation. In this study we report long-term outcomes of liver transplantation (LT) for HCC patients bridged/downstaged by Y90. Patients undergoing LT following Y90 between 2004-2018 were included, with staging by United Network of Organ Sharing (UNOS) TNM at baseline pre-Y90 and pre-LT. Post-Y90 toxicities were recorded. Histopathological data of HCC at explant were recorded. Long-term outcomes including overall survival (OS), recurrence-free survival (RFS), disease-specific mortality (DSM) and time-to-recurrence (TTR) were reported. Time-to-endpoint analyses were estimated using Kaplan-Meier. Uni/multivariate analyses were performed using log-rank test and Cox proportional hazards model, respectively. During the 15-year period, 207 patients underwent LT after Y90. OS from LT was 12.5 years, with median time to LT of 7.5 months (IQR: 4.4-10.3). 169 patients were bridged while 38 were downstaged to LT. 94 (45%), 60 (29%) and 53 (26%) patients showed complete, extensive and partial tumor necrosis on histopathology. Three, five and ten-year OS rates were 84%, 77%, and 60% respectively. Twenty-four patients developed recurrence, with median RFS of 120 (95%CI: 69-150) months. DSM at 3, 5 and 10 years was 6%, 11% and 16% respectively. There were no differences in OS/RFS for bridged or downstaged patients. RFS was higher in patients with complete/extensive versus partial tumor necrosis (p<0.0001). For UNOS T2 patients treated during the study period, 5.2% dropped out due disease progression. Conclusion: Y90 is an effective treatment for HCC in the setting of bridging/downstaging to LT. Patients who achieved extensive or complete necrosis had better RFS, supporting the practice of neoadjuvant treatment prior to LT.
U2 - 10.1002/hep.31318
DO - 10.1002/hep.31318
M3 - Article
C2 - 32416631
SN - 0270-9139
JO - Hepatology (Baltimore, Md.)
JF - Hepatology (Baltimore, Md.)
ER -