Systematic Review and Meta-Analysis of Posttransplant Hepatic Artery and Biliary Complications in Patients Treated With Transarterial Chemoembolization Before Liver Transplantation

Sneiders, Dimitri; Houwen, Thymen; Pengel, Liset; Polak, Wojciech; Dor, Frank J. M. F.; Hartog, Hermien

doi:10.1097/tp.0000000000001936

Cited by 33 publications

(20 citation statements)

References 36 publications

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“…Although TACE was associated with a higher occlusion rate in the AR/HCC subgroup in the present study, our multivariate analysis failed to identify TACE as a risk factor in either the entire or the primary LT cohort. A very recently published systematic review and meta‐analysis demonstrated that TACE was associated with arterial complications but not with HAT alone after LT . However, the vast majority of the individual studies in this meta‐analysis failed statistical significance of an association between TACE and arterial complications, which was the case in our study as well.…”

Section: Discussionsupporting

confidence: 50%

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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Section: Discussionsupporting

confidence: 50%

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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“…[6][7] On the other hand, there was no evidence in our study of an increase in the occurrence of HAT, biliary tract strictures or leaks which is in contrast to the recent meta-analysis of the impact of TACE on post-transplant complication that found evidence of an 1.6-fold increase in the frequency of hepatic artery complications. 5…”

Section: Comparison With Other Studiesmentioning

confidence: 99%

“…3 The procedure can induce decompensation of the cirrhotic liver and can also cause damage to the inner lining or the intima of the hepatic artery, potentially increasing the risk of hepatic artery thrombosis (HAT). [3][4][5] A recent systematic review representing 1 122 patients from 14 retrospective studies, found that TACE increased the overall risk of hepatic artery complications after liver transplantation. (5) So far, there is no evidence that the use of TACE in HCC patients on the waiting list for transplantation has an impact on post-transplant survival.…”

Section: Introductionmentioning

confidence: 99%

“…[3][4][5] A recent systematic review representing 1 122 patients from 14 retrospective studies, found that TACE increased the overall risk of hepatic artery complications after liver transplantation. (5) So far, there is no evidence that the use of TACE in HCC patients on the waiting list for transplantation has an impact on post-transplant survival. Analyses of the US Multicenter HCC Transplant Consortium (UMHTC) database, including 3601 transplantations carried out between 2002 and 2013, and the European Liver Transplant Registry (ELTR), including 4978 transplantations between 1990 to 2016 found no statistically significant effect of TACE.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Liver transplantation outcomes after transarterial chemotherapy for hepatocellular carcinoma

Wallace

Cowling

Walker

et al. 2020

British Journal of Surgery

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Background Transarterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC) awaiting liver transplantation is widespread, although evidence that it improves outcomes is lacking and there exist concerns about morbidity. The impact of TACE on outcomes after transplantation was evaluated in this study. Methods Patients with HCC who had liver transplantation in the UK were identified, and stratified according to whether they received TACE between 2006 and 2016. Cox regression methods were used to estimate hazard ratios (HRs) for death and graft failure after transplantation adjusted for donor and recipient characteristics. Results In total, 385 of 968 patients (39·8 per cent) received TACE. Five-year patient survival after transplantation was similar in those who had or had not received TACE: 75·2 (95 per cent c.i. 68·8 to 80·5) and 75·0 (70·5 to 78·8) per cent respectively. After adjustment for donor and recipient characteristics, there were no differences in mortality (HR 0·96, 95 per cent c.i. 0·67 to 1·38; P = 0·821) or graft failure (HR 1·01, 0·73 to 1·40; P = 0·964). The number of TACE treatments (2 or more versus 1: HR 0·97, 0·61 to 1·55; P = 0·903) or the time of death after transplantation (within or after 90 days; P = 0·291) did not alter the outcome. The incidence of hepatic artery thrombosis was low in those who had or had not received TACE (1·3 and 2·4 per cent respectively; P = 0·235). Conclusion TACE delivered to patients with HCC before liver transplant did not affect complications, patient death or graft failure after transplantation.

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“…The role of LRT in the setting of HCC and LT has not been fully clarified, mainly in light of the potential detrimental effects of repetitive treatments. For example, a recent meta-analysis performed on 1122 TACE patients showed an increased risk of post-LT hepatic artery complications (odds ratio = 1.57; P = 0.02)[ 10 ]. Another study from the US performed on 3601 patients all meeting the Milan Criteria, showed that the increasing number of LRT significantly predicted post-LT recurrence (3 LRTs: HR = 2.1; P < 0.001; 4 + LRTs: HR = 2.5; P < 0.001)[ 5 ].…”

Section: Perspectivementioning

confidence: 99%

Locoregional therapy response in patients with hepatocellular cancer waiting for liver transplantation: Only selection or biological effect?

Lai

Martino

Lucatelli

et al. 2018

WJG

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Locoregional treatments (LRT) represent a broad strategy used for reducing the risk of drop-off and contextually improving the survivals in patients with hepatocellular cancer receiving a liver transplantation (LT). However, it is not sufficiently clear if LRT are only a surrogate of tumor aggressiveness or if they consent a real benefit in terms of tumor stabilization. A recent study by Pommergaard et al reported the results from the European Liver Transplant Registry. Patients receiving LRT before LT had better 5-year survival rates respect to no-LRT cases (69.7% vs 65.8%; P < 0.001). When the number of LRT was tested, one-to-two treatments were connected with improved survivals respect to no treatment [hazard ratio (HR) = 0.85 and 0.71, respectively]. The efficacy of LRT was also reported in the presence of larger tumors (HR = 0.78) and micro-macrovascular invasion (HR = 0.71). The results observed in the present study are partially in discordance with other analyses showing a detrimental effect of LRT. The main problem in the interpretation of these results is connected with the possible initial selection biases present in the studies. The most recent guidelines suggest to perform LRT before the transplant, but the level of evidence is typically low due to the absence of prospectively designed studies.

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Systematic Review and Meta-Analysis of Posttransplant Hepatic Artery and Biliary Complications in Patients Treated With Transarterial Chemoembolization Before Liver Transplantation

Abstract: Patients treated with TACE before liver transplantation may be at increased risk for development of hepatic artery complications after liver transplantation.

Cited by 33 publications

References 36 publications

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

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

Liver transplantation outcomes after transarterial chemotherapy for hepatocellular carcinoma

Locoregional therapy response in patients with hepatocellular cancer waiting for liver transplantation: Only selection or biological effect?

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