Preoperative transarterial chemoembolization does not increase hepatic artery complications after liver transplantation: A single center 12-year experience

Li, Hongyu; Li, Bo; Yan, Lvnan; Wen, Tianfu; Wang, Wentao; Yang, Jiayin; Lu, Wusheng; Xu, Mingqing

doi:10.1016/j.clinre.2014.12.004

Cited by 13 publications

(24 citation statements)

References 17 publications

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“…Two reviewers reached an agreement on the finally included studies. A total of 2902 patients (TACE plus LT: 721 LT: 2181) from 7 retrospective cohort studies and 5 case control studies were included in the qualitative synthesis, [19][20][21][22][23][24][25][26][27][28][29][30] no randomized controlled trial was found. The essential characteristics are shown in Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…Perioperative mortality eight studies 20,21,[24][25][26][27]29 reported procedure-related mortality data. The heterogeneity between all eight studies was not statistically significant (P = 0.08, I 2 = 45%).…”

Section: Effects Of Interventionsmentioning

confidence: 99%

“…or hepatic artery stenosis can largely affect the graft function. A total of seven studies [19][20][21][22]27,28,30 reported on complications of vessel. No significant heterogeneity was found (P = 0.85, I 2 = 0%) The pooling of RRs revealed that the incidence of vascular complications was significantly higher in the TACE group (RR = 2.01, 95%CI = [1.…”

Section: Effects Of Interventionsmentioning

confidence: 99%

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Transarterial chemoembolization prior to liver transplantation for patients with hepatocellular carcinoma: A meta‐analysis

Chen

et al. 2017

J of Gastro and Hepatol

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Background and Aim A debate exists over whether using preoperative transarterial chemoembolization for patients with hepatocellular carcinoma before liver transplantation. Numerous studies have been investigating on this, but there is still no unanimous conclusion about the effect of preoperative transarterial chemoembolization. We conducted the meta‐analysis of all available studies to systematically evaluate the influence of preoperative transarterial chemoembolization on liver transplant. Methods A systematic search was performed by two authors (Si TF. and Guan RY.) through PubMed, Embase, Cochrane, and Science Citation Index Expanded, combined with Manual Retrieval and Cited Reference Search. The searching cut‐off date was 2016/07/31, and all the data obtained were statistically analyzed using Review Manager version 5.1 software (Copenhagen, The Nordic Cochrane Center, The Cochrane Collaboration, 2011) recommended by Cochrane Collaboration. Results The study showed that there was no difference between the experimental group and the control group on perioperative mortality (RR = 1.10, 95% confidence interval (CI) = [0.49–2.48], P = 0.82) or biliary complications (RR = 0.96, 95%CI = [0.66–1.39], P = 0.83). Preoperative transarterial chemoembolization had no obvious effect on improving overall survival (HR = 1.05, 95%CI = [0.65–1.72], P = 0. 83) but would result in a higher rate of vascular complications (RR = 2.01, 95%CI = [1.23–3.27], P = 0.005) and a reduction of disease free survival (HR = 1.66, 95%CI = [1.02–2.70], P = 0.04). Subgroup analysis also revealed that patients from transarterial chemoembolization group in Asia had a much lower overall survival rate (HR = 2.65, 95%CI = [1.49–4.71], P = 0.0009) compared with the control group. Conclusions Considering the possible adverse impacts on liver transplantation and the variation in sensitivity to transarterial chemoembolization, clinicians should be more cautious when considering transarterial chemoembolization as the bridging therapy for patients in the waiting list.

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Section: Resultsmentioning

confidence: 99%

Section: Effects Of Interventionsmentioning

confidence: 99%

Section: Effects Of Interventionsmentioning

confidence: 99%

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Transarterial chemoembolization prior to liver transplantation for patients with hepatocellular carcinoma: A meta‐analysis

Chen

et al. 2017

J of Gastro and Hepatol

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“…2,4 One of the most important factors involved in HAT is intimal dissection. This complication in the recipient hepatic artery may be recognized at the time of transplant surgery, and it results in occlusion of the artery.…”

Section: Discussionmentioning

confidence: 99%

“…There is a risk of damage to the hepatic artery while placing the catheter, either from mechanical injury or from the chemotherapeutic agents administered (eg, doxorubicin hydrochloride, mitomycin C). 1,2 The literature reflects the ongoing controversy over the effects of TACE administration before liver transplantation on postoperative hepatic artery complications. We aimed to investigate the relation of preoperative TACE and hepatic artery thrombosis (HAT) after liver transplantation.…”

Section: Introductionmentioning

confidence: 99%

Untitled

Nykonenko

Vávra²,

Zonča³

2017

Exp Clin Transplant

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Objectives: Transarterial chemoembolization is a potential risk factor for hepatic artery damage, which may lead to severe consequences. We aimed to investigate this controversial issue in our population of liver transplant patients with hepatocellular carcinoma. Materials and Methods: Between March 2006 and December 2016, a total of 262 patients with hepatocellular carcinoma underwent liver transplant at our institution. Of these, 22 (8.4%) had preoperative transarterial chemoembolization. We retrospectively reviewed the data of all patients, comparing those who did and did not undergo transarterial chemoembolization. Results: The groups were similar in terms of patient sex, mean age, mean alpha-fetoprotein levels, and Milan criteria. The nontransarterial chemoembolization group had a significantly higher mean Model for End-Stage Liver Disease score. Hepatic artery thrombosis after liver transplantation was diagnosed in 6 of 22 patients (27%) in the transarterial chemoembolization group and in 12 of 240 patients (5%) in the non transarterial chemoembolization group (P = .002). Retransplant was performed in 5 of the 6 patients with hepatic artery thrombosis in the transarterial chemo embolization group and 3 of the 12 patients in the nontransarterial chemoembolization group (P = .04). Conclusions:In patients who undergo transarterial chemoembolization before liver transplantation, the incidence of hepatic artery thrombosis and retransplantation is significantly higher than in those who do not undergo this intervention. The tissues should be carefully handled at the time of transplantation to prevent trauma that may cause intimal dissection in the fragile vessels.

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Hepatic artery occlusion in liver transplantation: What counts more, the type of reconstruction or the severity of the recipient's disease?

Oberkofler¹,

Reese²,

Raptis³

et al. 2018

Liver Transpl

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Although the type of hepatic artery revascularization technique is known to have an impact on patency rates, independent perioperative risk factors on patient outcomes are poorly defined. All consecutive adult patients undergoing cadaveric liver transplantation (n = 361) from July 2007 to June 2016 in a single institution were analyzed. Primary outcomes were early (<30 days) hepatic artery occlusion and primary hepatic artery patency rate. A multivariate model was used to identify independent risk factors for occlusion and the need of arterial conduit, as well as their impact on graft and patient survival. Arterial revascularization without additional reconstruction (end-to-end arterial anastomosis [AA]) was performed in 77% (n = 279), arterial reconstruction (AR) in 15% (n = 53), and aortohepatic conduit (AHC) in 8% (n = 29) of patients. AHC had the highest mean intraoperative flow (275 mL/minute; P = 0.02) compared with AA (250 mL/minute) and AR (200 mL/minute; P = 0.02). There were 43 recipients (12%) who had an occlusive event with successful revascularization in 20 (47%) recipients. One-year primary patency rates of AA, AR, and AHC were 97%, 88%, and 74%, respectively. Aortic calcification had an impact on early occlusion. AR (odds ratio [OR], 3.68; 95% confidence interval [CI], 1.26-10.75; P = 0.02) and AHC (OR, 6.21; 95% CI, 2.02-18.87; P = 0.001) were independent risk factors for early occlusion. Dyslipidemia additionally independently contributed to early occlusion (OR, 2.74; 95% CI, 0.96-7.87; P = 0.06). The 1- and 5-year graft survival rates were 83% and 70% for AA, 75% and 69% for AR, and 59% and 50% for AHC (P = 0.004), respectively. In conclusion, arterial patency is primarily determined by the type of vascular reconstruction rather than patient or disease characteristics. The preoperative lipid status is an independent risk factor for early occlusion, whereas overall occlusion is only based on the performed vascular reconstruction, which is also associated with reduced graft and patient survival. Liver Transplantation 24 790-802 2018 AASLD.

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Preoperative transarterial chemoembolization does not increase hepatic artery complications after liver transplantation: A single center 12-year experience

Cited by 13 publications

References 17 publications

Transarterial chemoembolization prior to liver transplantation for patients with hepatocellular carcinoma: A meta‐analysis

Transarterial chemoembolization prior to liver transplantation for patients with hepatocellular carcinoma: A meta‐analysis

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Hepatic artery occlusion in liver transplantation: What counts more, the type of reconstruction or the severity of the recipient's disease?

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