Liver transplant mortality and morbidity following preoperative radiotherapy for hepatocellular carcinoma

Abstract

Background: Radiotherapy (RT) can be used for tumor downstaging and as a bridge to transplantation in hepatocellular carcinoma (HCC), but its effect on surgical complications is unknown. Therefore, we investigated post-transplant mortality and acute readmission rates in HCC with and without preoperative RT using the National Cancer Database (NCDB).Methods: After exclusion, 11,091 transplant patients were analyzed, 165 of whom received RT prior to transplant. Multivariable binomial logistic regression analysis identified characteristics associated with use of RT, and factors associated with increased 30/90-day mortality and 30-day readmission, following propensity matching.Results: Although RT (median 40 Gy in 5 fractions) was more often delivered to larger tumors and advanced stages, it resulted in 59% downstaging rate, 39% pathologic complete response rate, and a median of 4 additional months to transplantation. Crude 30/90-day mortality rates were both 1.2% with preoperative RT, compared to 2.7% and 4.4% without. The 30-day readmission rate was 5.5% with RT and 10.7% without it. Propensity matched analysis demonstrated no statistical differences in 30/90-day mortality and a lower 30-day readmission rate with preoperative RT. Age >58, stage III disease, lack of transarterial chemoembolization, and shorter time to transplant independently predicted higher 90-day mortality. Conclusion:Preoperative RT for HCC did not increase postoperative mortality or length of stay following liver transplant.

Outcomes After Stereotactic Body Radiation Therapy as a Bridging Modality to Liver Transplantation for Hepatocellular Carcinoma

“…There were cases of diaphragmatic hernia, gastric perforation, and intra-abdominal hematoma, which were all found to be located distant from the radiation treatment field such that these areas received negligible radiation dose. This is consistent with the findings of the National Cancer Database analysis by Hasan et al, 28 which identified 165 patients treated with RT before LT without significant increase in perioperative mortality or hospital length of stay.…”

KIF2C promotes the proliferation of hepatocellular carcinoma cells in vitro and in vivo

“…HCC is prone to metastasis and targeted therapy with liposomes has been shown to be effective ( 26 , 27 ). In recent years, targeted therapy has demonstrated the most effective results for HCC, and several targeted therapy drugs remain in clinical trials ( 28 ). In the present study, using TCGA database analysis and IHC staining assays, high KIF2C expression levels were identified in human HCC tissues.…”

Stereotactic radiotherapy for hepatocellular carcinoma: Expanding the multidisciplinary armamentarium

“…39 An analysis of 11 091 liver transplant patients within the NCDB identified 165 patients with HCC who received preoperative RT. 40 Although RT was more often delivered to larger tumors at more advanced stages, its use before OLT did not increase postoperative mortality or length of stay. Preliminary data from the first 29 patients treated in the Lahey Clinic randomized phase 2 trial (NCT02182687) of SABR versus TACE as bridging therapy pre-OLT has been reported in abstract form and showed that SABR may be associated with fewer days of inpatient admission and fewer retreatments.…”

“…An analysis of 11 091 liver transplant patients within the NCDB identified 165 patients with HCC who received preoperative RT 40 . Although RT was more often delivered to larger tumors at more advanced stages, its use before OLT did not increase postoperative mortality or length of stay.…”