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241 EFFECTIVENESS OF PREOPERATIVE CHEMOEMBOLIZATION FOR HEPATOCELLULAR CARCINOMA IN LIVER TRANSPLANT CANDIDATES PRE- AND POST MODEL FOR END-STAGE LIVER DISEASE.
  1. C. E. Taghavi1,
  2. M. Meehan2,
  3. S. D. Colquhoun2
  1. 1David Geffen School of Medicine at UCLA, Los Angeles, CA
  2. 2Center for Liver Diseases and Transplantation, Cedars-Sinai Medical Center, Los Angeles, CA.

Abstract

Purpose To evaluate the impact of hepatic artery chemoembolization (HACE) at our center before and after the implementation of the MELD organ allocation system.

Methods A single-center retrospective review of transplant candidates with HCC treated with HACE. Primary end points included transplantation versus progression beyond transplant criteria/death. Secondary end points included incidence of HACE-related complications and survival. Parameters studied included clinical stage at the time of HACE, findings of imaging and explant pathology, as well as the interval from HACE to a primary end point. Patients were categorized according to the transplant listing date relative to February 27, 2002, as pre-MELD and post-MELD era. Statistical comparisons were made using a two-tailed t-test and survival was determined using the Kaplan-Meier method (GraphPad Prism® v4.0c).

Results Of 26 pre-MELD era patients, 19 (73%) were transplanted (mean wait = 357.2 days), with 1-, 3-, and 5-year survivability of 73%, 55%, and 44%, respectively. Seven (27%) were removed from the waiting list due to increased tumor burden or death at a mean time of 185.3 days, with 1- and 3- year survivability of 17% (p = .0096). Of the 35 post-MELD era patients, 17 (48%) were transplanted (mean = 161.7 days) with 1- and 3-year survivability of 87%. Nine (26%) were removed from the list (mean wait = 218.4 days) with a 1-year survivability of 0% (p = .0032). Nine (26%) patients remain listed in stable condition (mean = 332 days). No serious HACE-related complications were reported in either group, and survival was excellent (100%).

Conclusions HACE was associated with significant tumor necrosis in both pre- and post-MELD era patients, as evidenced by imaging and pathology. This study shows that although pre- and post-MELD era patients experienced almost identical progression of disease precluding transplantation, post-MELD patients had improved survivability following transplantation. Given the efficacy of HACE, this therapy continues to have a positive impact on pretransplant candidates.

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