Y-90 vs. TACE Histopathologic Outcomes in Patients with HCC Who Underwent Orthotopic Liver Transplant: A Single-Center, 7-Year Experience

Monday, March 6, 2023

3:45 PM – 3:54 PM

Location: Phoenix Convention Center, 224AB

Presenting Author(s)

Rachel Todd, BA (she/her/hers)

Medical Student
Icahn School of Medicine At Mount Sinai

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

Alex Sher, MD

Interventional Radiology Resident
Icahn School of Medicine at Mount Sinai
AY

Anthony Yang, MD

Resident
Mount Sinai
Dan Shilo, MD

Assistant Professor
Mount Sinai
KG

Kirema Garcia-Reyes, MD

Assistant Professor
Mount Sinai
Vivian Bishay, MD

Associate Professor
Icahn School of Medicine at Mount Sinai Hospital
Rahul S. Patel, MD, FSIR

Professor of Radiology and Surgery
Mount Sinai Medical Center
AF

Aaron M. Fischman, MD

Professor of Radiology and Surgery
Mount Sinai Health System
Scott Nowakowski, MD

Professor of Radiology and Surgery / Vice-Chair
Mount Sinai Health System
RL

Robert A. Lookstein, MD

Professor of Radiology and Surgery
Icahn School of Medicine at Mount Sinai
Parissa Tabrizian, MD

Associate Professor of Surgery
Recanati/Miller Transplant Institute
Edward Kim, MD (he/him/his)

Professor of Radiology and Surgery
Mount Sinai Health System

Disclosure(s):

Rachel Todd, BA: No financial relationships to disclose

Alex Sher, MD: No financial relationships to disclose

Kirema Garcia-Reyes, MD: No financial relationships to disclose

Scott Nowakowski, MD: No financial relationships to disclose

Robert A. Lookstein, MD: No relevant disclosure to display

Purpose: Locoregional therapies (LRT) such as trans-arterial radioembolization (TARE), transarterial chemoembolization (TACE), and thermal ablation (TA) are all used for bridging or downstaging unresectable hepatocellular carcinoma for transplant. Achieving a complete pathologic response has been shown to improve oncologic outcomes such overall and recurrence free survival. However, there is lack of consensus on which LRT is best for achieving this goal. Our aim was to compare pathologic outcomes between TARE with yttrium-90 (Y90) and TACE with or without thermal ablation.

Materials and Methods: Patients whom were treated with LRT and whom underwent liver transplant between January 2010 and December 2017 were retrospectively reviewed. Pre-procedural data and procedural details including demographic information, etiology of disease, Child Pugh (CP), BCLC score, and lesion location were recorded. Histopathologic evaluation of the explanted liver and post transplant outcomes such as recurrence and mortality were assessed within two years. Bivariate and multivariate multinomial logistic regression was performed.

Results: A cohort of 253 lesions in 242 patients which were treated with either TARE or TACE with or without thermal ablation was analyzed. Of these, 38 lesions were treated with TARE and 215 lesions were treated with TACE with or without ablation. Overall, the demographics including CP (80% vs 70% CPA), BCLC (BCLCA 79% vs 87%), and mean lesion size (2.2 vs. 2.3 cm) were similar between groups. Complete pathologic necrosis was achieved in 26 of 38 (68.4%) after TARE compared to 87 of 215 (40.5%) lesions after TACE with or without ablation (p=.01). In total, there were eight (3.3%) recurrences after transplant with only one intrahepatic recurrence and no difference between groups. Eighteen (7.4%) deaths occurred within two years. Median PFS and overall survival was not reached. Independent predictors for achieving complete pathologic necrosis were TARE (OR 2.7 95% CI 0.9-8.0; p=0.009) and Hepatitis B virus (OR 3.5 95% CI 1.2-10.6).

Conclusion: TARE was significantly more likely to achieve complete pathologic necrosis when compared to TACE with or without ablation in HCC lesions treated before liver transplant.