Pre-transplant locoregional therapy and post-transplant outcomes in hepatocellular carcinoma: a single-center retrospective cohort study.
- 1Multiorgan Transplant Centre of Excellence, Liver Transplantation Unit, King Fahad Specialist Hospital, Dammam, Saudi Arabia.
- 2Department of Medicine, Zamzam University College, Khartoum, Sudan.
- 3Department of Surgery, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
Abstract
Pre-transplant locoregional therapy (LRT), most commonly transarterial chemoembolization (TACE) or transarterial radioembolization (TARE), is used as bridging or downstaging treatment in selected patients with hepatocellular carcinoma (HCC) who undergo liver transplantation (LT). Defining post-transplant outcomes after LRT is important for refining selection, counseling, and program-level care. This study aimed to characterize pre-transplant TACE/TARE use, downstaging success, post-transplant outcomes in a single-center HCC transplant cohort. We conducted a retrospective single-center cohort study of 113 consecutive patients who underwent LT for HCC at King Fahad Specialist Hospital, Dammam, Saudi Arabia, during 2014-2024. Twenty-four patients received TACE and/or TARE before LT and 89 did not. Liver-transplant eligibility was assessed using the Milan criteria: a single tumor ≤5 cm or up to three tumors each ≤3 cm, with no macrovascular invasion or extrahepatic spread. Baseline characteristics and post-transplant outcomes were summarized using available-case denominators. Downstaging was assessed among 14 LRT-treated patients whose tumor burden initially exceeded Milan criteria. Recurrence-free survival (RFS) was estimated with Kaplan-Meier methods and compared using the log-rank test. The study was approved by the Institutional Review Board of King Fahad Specialist Hospital (MOTC0044). The LRT group had a higher median total tumor burden than the no-LRT group (4.0 vs. 3.0 cm; P=0.03) and a different etiology distribution, including a higher proportion of HCV (54.2% vs. 21.8%; P=0.03). Successful downstaging to Milan criteria was documented in 8 of 14 LRT-treated patients (57.1%). RFS curves were closely aligned between groups (log-rank P=0.97). HCC recurrence occurred in 7 of 113 patients (6.2%). Biliary, infectious, and rejection complications occurred in 16/85 (18.8%), 36/88 (40.9%), and 19/88 (21.6%), respectively, using available-case denominators. Pre-transplant TACE/TARE was used selectively in patients with greater tumor burden and achieved documented downstaging to Milan criteria in 57.1% of treated patients beyond criteria. Post-transplant RFS was comparable between groups, while overall recurrence and complication frequencies were low in the cohort. These findings provide a clinically relevant regional benchmark and support prospective evaluation of LRT within standardized transplant pathways.
Related
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- The Efficacy and Safety of Combined Locoregional and Systemic Therapy versus Systemic Therapy Alone in Patients with Hepatocellular Carcinoma and Portal Vein Tumor Thrombosis: A Multicenter Real-World Retrospective Cohort Study.
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- Curative Locoregional Therapy following Objective Response to Atezolizumab plus Bevacizumab in Unresectable Hepatocellular Carcinoma.
BibTeX
@article{gadour2026pretransplant,
title = {{Pre-transplant locoregional therapy and post-transplant outcomes in hepatocellular carcinoma: a single-center retrospective cohort study.}},
author = {Eyad Gadour and Elsayed Abdulaziz Gadalla and Iftikhar Khan and Rayyan Badr and Mansour Tawfeeq and Howra Al-Hashim and Sharafeldin Zarrouq and Rahmah Alsaad and Neriman Alali and Lama Almubarak and Hala Ali and Omar Alanazi and Mohammed AlQahtani},
journal = {Journal of gastrointestinal oncology},
year = {2026},
month = sep,
doi = {10.21037/jgo-2026-0883},
url = {https://europepmc.org/article/MED/42996615},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Pre-transplant locoregional therapy and post-transplant outcomes in hepatocellular carcinoma: a single-center retrospective cohort study.
AU - Eyad Gadour
AU - Elsayed Abdulaziz Gadalla
AU - Iftikhar Khan
AU - Rayyan Badr
AU - Mansour Tawfeeq
AU - Howra Al-Hashim
AU - Sharafeldin Zarrouq
AU - Rahmah Alsaad
AU - Neriman Alali
AU - Lama Almubarak
AU - Hala Ali
AU - Omar Alanazi
AU - Mohammed AlQahtani
PY - 2026
DA - 2026/09/29
JO - Journal of gastrointestinal oncology
DO - 10.21037/jgo-2026-0883
UR - https://europepmc.org/article/MED/42996615
AB - Pre-transplant locoregional therapy (LRT), most commonly transarterial chemoembolization (TACE) or transarterial radioembolization (TARE), is used as bridging or downstaging treatment in selected patients with hepatocellular carcinoma (HCC) who undergo liver transplantation (LT). Defining post-transplant outcomes after LRT is important for refining selection, counseling, and program-level care. This study aimed to characterize pre-transplant TACE/TARE use, downstaging success, post-transplant outcomes in a single-center HCC transplant cohort. We conducted a retrospective single-center cohort study of 113 consecutive patients who underwent LT for HCC at King Fahad Specialist Hospital, Dammam, Saudi Arabia, during 2014-2024. Twenty-four patients received TACE and/or TARE before LT and 89 did not. Liver-transplant eligibility was assessed using the Milan criteria: a single tumor ≤5 cm or up to three tumors each ≤3 cm, with no macrovascular invasion or extrahepatic spread. Baseline characteristics and post-transplant outcomes were summarized using available-case denominators. Downstaging was assessed among 14 LRT-treated patients whose tumor burden initially exceeded Milan criteria. Recurrence-free survival (RFS) was estimated with Kaplan-Meier methods and compared using the log-rank test. The study was approved by the Institutional Review Board of King Fahad Specialist Hospital (MOTC0044). The LRT group had a higher median total tumor burden than the no-LRT group (4.0 vs. 3.0 cm; P=0.03) and a different etiology distribution, including a higher proportion of HCV (54.2% vs. 21.8%; P=0.03). Successful downstaging to Milan criteria was documented in 8 of 14 LRT-treated patients (57.1%). RFS curves were closely aligned between groups (log-rank P=0.97). HCC recurrence occurred in 7 of 113 patients (6.2%). Biliary, infectious, and rejection complications occurred in 16/85 (18.8%), 36/88 (40.9%), and 19/88 (21.6%), respectively, using available-case denominators. Pre-transplant TACE/TARE was used selectively in patients with greater tumor burden and achieved documented downstaging to Milan criteria in 57.1% of treated patients beyond criteria. Post-transplant RFS was comparable between groups, while overall recurrence and complication frequencies were low in the cohort. These findings provide a clinically relevant regional benchmark and support prospective evaluation of LRT within standardized transplant pathways.
SN - 2078-6891
SN - 2219-679X
ER -