Irreversible Electroporation as a Bridge to Liver Transplantation

Abstract

Hepatocellular carcinoma (HCC) in proximity to major hepatic vasculature poses a risk for invasion, which would contraindicate liver transplantation, yet, is difficult to treat with thermal ablation. This study was undertaken to evaluate the feasibility of irreversible electroporation (IRE) as a bridge to transplantation for high-risk tumors. All patients with HCC in proximity to major hepatic vasculature treated with laparoscopic IRE as bridge to transplantation were studied. Patient and tumor characteristics, length of stay, and treatment-related complications were recorded. Tumor response was assessed with CT and explant pathology. Five patients with a median Model for End Stage Liver Disease (MELD) of 13 (7–21) underwent IRE. The median tumor size was 2.7 cm (1.5–3.7 cm). Adjacent structures included the right portal vein, hepatic veins/inferior vena cava (IVC) and left portal vein. Length of stay was one day for all patients. One patient suffered portal vein thrombosis. The transplant occurred at a median of 142 days (47–264) after IRE. Pathologic necrosis ranged from 30 to 100 per cent, without any vascular invasion. Four patients remain alive with no evidence of disease with median follow-up of 403 (227–623) days. The remaining patients died because of transplant-related complications onpost IRE day 297. IRE shows promise as a bridge to liver transplant for high risk HCC in a preliminary series, justifying further prospective evaluation.

Association Of Electroencephalogram Patterns With Ammonia Levels In Hepatic Encephalopathy Patients

“…It is justified, because most of the patients usually presented to the hospital for treatment in early stages and they are treated before progression of the disease to HE grade IV. Previous studies depicted that acute HE is reversible through various liver treatment or transplant procedures (29,30) while chronic or grade IV HE is hard to recover except liver transplantation.…”

Irreversible electroporation: present and future in the treatment of hepatocellular carcinoma

“…Una nueva indicación para el tratamiento con IRE en pacientes con CHC, ya descrita para RFA y microondas 46 , es la publicada en 2019 por Cannon y col 47 : como tratamiento puente que permita un posterior trasplante hepático. Su serie incluyó cinco pacientes de alto riesgo debido a una función hepática terminal y con CHC localizados cerca de grandes vasos hepáticos (vena cava intrahepática, porta derecha o venas suprahepáticas).…”

Interventional Radiology Image-Guided Locoregional Therapies (LRTs) and Immunotherapy for the Treatment of HCC

“…Furthermore, treatment requires general anesthesia, paralysis, and cardiac synchronization [ 176 ]; high-frequency IRE (HFIRE), the next generation of IRE that does not require cardiac synchronization and paralytic agents, could minimize these difficulties in the near future [ 177 ]. IRE has been generally used in HCC cases where thermal ablation was considered unsuitable or at high risk of complications including the setting of bridge to transplantation [ 178 , 179 , 180 ]. Regarding efficacy, a recent review of nine major studies focused on IRE in the treatment of liver cancers (the majority being HCC) reported a primary efficacy rate of 66–100%, a local recurrence rate of 5–34%, and general and major complication rates of 11–42% and 3–11%, respectively [ 181 ].…”