{
  "abstract": "Background\n\nComplete pathologic necrosis (CPN) is associated with improved outcomes after liver transplantation for HCC. Whether this association persists after accounting for hepatic reserve, tumor burden, locoregional therapy modality, and risk of waitlist dropout remains uncertain.Methods\n\nWe conducted a retrospective cohort study using the Organ Procurement and Transplantation Network Standard Transplant Analysis and Research database, comprising 16,955 adult recipients bridged with locoregional therapy and a comparator group of 5867 recipients with no evidence of pretransplant treatment. Multivariable models were adjusted for hepatic reserve, tumor burden at original presentation, alpha-fetoprotein, and transplant era.Results\n\nCPN was achieved in 5,132 patients (30.3%) and was associated with improved survival (adjusted HR: 0.73, 95% CI: 0.68-0.78) and reduced recurrence (adjusted HR: 0.37, 95% CI: 0.31-0.44). Outcomes were similar whether necrosis was absent or incomplete (adjusted HR: 1.39 and 1.37 vs. complete necrosis). Relative to the no treatment comparator, no adjusted survival advantage was detected for treatment without CPN (HR: 0.95, 95% CI: 0.89-1.01), whereas recurrence was higher (HR: 1.44, 95% CI: 1.25-1.66). Compared with transarterial chemoembolization, transarterial radioembolization and percutaneous ablation were associated with higher odds of CPN (adjusted odds ratios 2.19 and 1.84; both p<0.001). This association was observed in both baseline waitlist-dropout risk groups.Conclusions\n\nCPN was strongly associated with reduced posttransplant tumor recurrence and improved overall survival. Radioembolization and thermal ablation were the locoregional therapy modalities most likely to achieve CPN. These findings further establish CPN as an important objective of bridging and downstaging therapy.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Radiology, Division of Vascular and Interventional Radiology, University of California San Diego, La Jolla, California, USA.",
    "Department of Interventional Radiology, Mayo Clinic Florida, Jacksonville, Florida, USA.",
    "Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA.",
    "Department of Transplantation, Mayo Clinic Florida, Jacksonville, Florida, USA.",
    "Departments of Radiology, Medicine, and Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.",
    "Department of Surgery, Division of General Surgery, Section of Transplant Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA.",
    "Department of Radiology, University of California San Diego, La Jolla, California, USA.",
    "Department of Medicine, Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, California, USA."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 9,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Zachary T Berman",
      "orcid": "0000-0002-8651-9772"
    },
    {
      "affs": [
        1
      ],
      "name": "Beau B Toskich"
    },
    {
      "affs": [
        2
      ],
      "name": "Christopher D Malone"
    },
    {
      "affs": [
        3
      ],
      "name": "Kristopher P Croome"
    },
    {
      "affs": [
        4
      ],
      "name": "Robert J Lewandowski"
    },
    {
      "affs": [
        4
      ],
      "name": "Riad Salem"
    },
    {
      "affs": [
        5
      ],
      "name": "Maria B Majella Doyle"
    },
    {
      "affs": [
        6
      ],
      "name": "Kyril L Cole"
    },
    {
      "affs": [
        7
      ],
      "name": "Neil Mehta"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/5m04a8hg6zy7c.bib",
  "cited_by": 0,
  "doi": "10.1097/hc9.0000000000001074",
  "fulltext_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13694077/?tool=EBI",
  "id": "5m04a8hg6zy7c",
  "issns": [
    "2471-254X"
  ],
  "landing_url": "https://europepmc.org/article/PMC/PMC13694077",
  "language": "eng",
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2721|Hepatocellular Carcinoma Treatment and Prognosis"
    ]
  ],
  "openalex": "W7223799769",
  "pdf_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13694077/pdf/?tool=EBI",
  "pmcid": "PMC13694077",
  "pmid": "42951880",
  "published": "2026-10-23",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/5m04a8hg6zy7c.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:00Z",
      "native_id": "PMC:PMC13694077",
      "source": "europepmc",
      "url": "https://europepmc.org/article/PMC/PMC13694077"
    },
    {
      "first_seen": "2026-10-31T00:20:34Z",
      "native_id": "MED:42951880",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42951880"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2721|Hepatocellular Carcinoma Treatment and Prognosis",
      "subfield": "general"
    }
  ],
  "title": "Complete necrosis of HCC improves recurrence-free and overall survival after transplantation independent of baseline risk",
  "title_text": "Complete necrosis of HCC improves recurrence-free and overall survival after transplantation independent of baseline risk",
  "type": "peer-reviewed",
  "updated_at": "2026-10-31T00:20:34Z",
  "url": "https://research.draconitic.com/paper/5m04a8hg6zy7c",
  "venue": "Hepatology communications",
  "versions": []
}