Role of transarterial chemoembolization (TACE) in down staging of hepatocellular carcinoma (HCC) before liver transplantation

Abstract

In conclusion, TACE appears to be useful in the management of HCC associated with cirrhosis before liver resection or transplantation. TACE contributes to accurate staging of the intrahepatic disease, and response to treatment with downstaging or total necrosis of the tumor, obtained in near all treated cases, was accompanied by a benefit in survival. In liver resection, TACE is indicated particularly for tumors exceeding the Milan criteria, which are more likely to respond with downstaging, resulting in improved surgical access and resectability. We report excellent post-transplant outcome after successful down-staging of HCC prior to LT to meet the Milan Criteria. In spite of limitations of the present study, the overall low rate of HCC recurrence after LT and the low incidence of either poorly differentiated grade or microvascular invasion in the liver explant support the role of down-staging in the selection of patients with tumors of more favorable biology that respond to LRT and also do well after LT.