Introduction: Transarterial embolization (TAE) is a well-established modality of treatment for downstaging hepatocellular carcinoma (HCC) cases prior to liver transplantation. Hepatitis C virus (HCV) related HCC is difficult to manage even with liver transplantation because of the almost universal recurrence of HCV post transplantation and the risk of the transplanted liver undergoing subsequent fibrosis. Hence to address this issue, we evaluated the impact of TAE in HCV related HCC patients undergoing living donor liver transplantation (LDLT). The long-term outcomes of these cases are analyzed in this study.

Materials and Methods: We retrospectively evaluated the outcome in those post LDLT patients with HCV related HCC who received TAE intervention and those who did not. The demographic, clinical and pre-operative surgical factors were compared among the 2 groups. The waiting time pre LDLT as well as the overall patient survival and the HCC recurrence free survival were compared between the 2 groups. The tumors were downstaged in the TAE group to fit the UCSF criteria. The prognostic risk factors for HCC recurrence post LDLT were analyzed using the univariate and multivariate analysis.

Results: Over an 8 year period (2002 to 2010), a total of 62 patients having HCV related HCC underwent LDLT at Kaohsiung Chung Gung Memorial Hospital, Taiwan. For the entire cohort study, the mean duration of follow-up was 4.37 ± 2.29 years. The 2 groups were well matched except for the Childs C score, which was more in non-TAE group (p=0.007). The median waiting time for LDLT in TAE group was 11.91 months (range, 6.67- 31.23 months) which was significantly more than that in the non-TAE group, which was 3 months (range, 2-3.33), p=0.029. Post TAE 27 patients were within UCSF criteria and 3 were within UCSF but outside Milans criteria. There were 19 cases overall, having rapid progression of fibrosis (>0.8 fibrosis score/year). The overall survival in the TAE group, both at 5 and10 years was 92%, and in the non-TAE group was 96.9% and 48.4% respectively. The recurrence rate was 15.6% (5/32), in the non TAE group and was 0% (0/30), in the TAE group; p=0.019.

Conclusions: Pre LDLT, TAE was effective in downstaging tumor as well as in lowering the HCC recurrence rate in patients having HCV related HCC and fitting the UCSF criteria.