Complete necrosis of HCC improves recurrence-free and overall survival after transplantation independent of baseline risk
8 affiliations
- 1Department of Radiology, Division of Vascular and Interventional Radiology, University of California San Diego, La Jolla, California, USA.
- 2Department of Interventional Radiology, Mayo Clinic Florida, Jacksonville, Florida, USA.
- 3Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA.
- 4Department of Transplantation, Mayo Clinic Florida, Jacksonville, Florida, USA.
- 5Departments of Radiology, Medicine, and Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
- 6Department of Surgery, Division of General Surgery, Section of Transplant Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA.
- 7Department of Radiology, University of California San Diego, La Jolla, California, USA.
- 8Department of Medicine, Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, California, USA.
Abstract
Background
Complete 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
We 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
CPN 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
CPN 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.
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BibTeX
@article{berman2026complete,
title = {{Complete necrosis of HCC improves recurrence-free and overall survival after transplantation independent of baseline risk}},
author = {Zachary T Berman and Beau B Toskich and Christopher D Malone and Kristopher P Croome and Robert J Lewandowski and Riad Salem and Maria B Majella Doyle and Kyril L Cole and Neil Mehta},
journal = {Hepatology communications},
year = {2026},
month = oct,
doi = {10.1097/hc9.0000000000001074},
url = {https://europepmc.org/article/PMC/PMC13694077},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Complete necrosis of HCC improves recurrence-free and overall survival after transplantation independent of baseline risk
AU - Zachary T Berman
AU - Beau B Toskich
AU - Christopher D Malone
AU - Kristopher P Croome
AU - Robert J Lewandowski
AU - Riad Salem
AU - Maria B Majella Doyle
AU - Kyril L Cole
AU - Neil Mehta
PY - 2026
DA - 2026/10/23
JO - Hepatology communications
DO - 10.1097/hc9.0000000000001074
UR - https://europepmc.org/article/PMC/PMC13694077
AB - Background Complete 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 We 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 CPN 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 CPN 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.
SN - 2471-254X
ER -