The Number and Response to Locoregional Therapy as a Bridge to Transplant Improves Overall Survival in Hepatocellular Carcinoma Patients After Liver Transplantation: An Observational Study: 2106

Introduction: With continual organ shortage, liver transplant (LT) wait list (WL) times are prolonging. For Hepatocellular carcinoma (HCC), WL of over 6-12 months is a risk factor for tumor progression beyond Milan's criteria. Locoregional therapies (LRT) are used as bridge to LT and decrease dropout rates. The data on the number of LRTs, and the response to LRT as assessed by mRECIST with their impact on survival is scarce. We aim to study the impact of the number and radiologic response to LRT, on overall survival in WL patients who undergo LT. Methods: 77 consecutive patients with liver cirrhosis (Mean age 60 ± 6.5 years, M/F=61:16) from our prospectively compiled database listed for LT from January 2009 to August 2014 for HCC were included. Tumor response by mRECIST was classified as favorable response (FR) including complete necrosis or partial response and unfavorable response (UR) including stable disease or progression. Survival was estimated using Kaplan-Meyer analysis and p-value of < 0.05 was considered significant. Results: Of 77 enrolled patients 54 had atleast one LRT performed. Among 13 who did not recieve LRT but underwent LT; 4 had HCC diagnosed on explant and 9 were transplanted within 6 weeks of HCC diagnosis and their lab MELD was higher than patients who received LRT(p< 0.001). From the 54 patients who recieved LRT while on WL, 14 were delisted: 8 due to HCC progression and 6 due to multiple comorbidities. 40 patients who had atleast 1 LRT underwent LT, mRECIST data was not available on only 1 patient.The 5 year survival (Figure 1) among LT recipients who received > 2 LRTs and had FR was 100% (4/4) and who had unfavorable response was 86% (1/7 deaths). The 5 year survival in LT recipients who received 2 LRTs and had favorable response had the best post-LT survivals. The median OS of 77 patients listed for LT was 5.3 years. HCC related mortality in patients who had LRT before LT was 5% (2/40). This was lower than in non-LRT transplanted patients who showed HCC related mortality of 15.4% (2/13). This difference was not statistically significant.Figure 1Conclusion: In our patient cohort, more than 2 LRTs and a favorable response to LRT improved posttransplant survivals in LT recipients. Prospective randomized trials are warranted