The Impact of Bridging LRT on Survival in Patients Listed for Liver Transplantation

Habibollahi, Peiman; Hunt, Stephen; Gade, T.; Dagli, Mandeep; Mondschein, Jeffrey I.; Sudheendra, Deepak; Stavropoulos, S. William; Soulen, Michael C.; Nadolski, G.

doi:10.1007/s00270-017-1759-1

Cited by 6 publications

(12 citation statements)

References 20 publications

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“…M inimal invasive cancer treatments, such as conventional transarterial chemoembolization (C-TACE), 1,2 are increasingly used in palliative oncology [3][4][5] and bridging therapy to facilitate liver transplantation. [6][7][8] In this context, combining tolerable radiation exposure with the best possible image quality (IQ) remains crucial in interventional radiology.…”

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confidence: 99%

Advanced Robotic Angiography Systems for Image Guidance During Conventional Transarterial Chemoembolization

et al. 2019

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Objectives: The aim of this study was to compare 2 advanced robotic angiography systems for real-time image guidance in terms of radiation dose and image quality (IQ) during conventional transarterial chemoembolization (C-TACE) of hepatic malignant tumors. Materials and Methods: One hundred six patients (57 women/49 men; mean age, 60 ± 11 years) who had undergone C-TACE using 2 generations of robotic angiography platforms for image guidance were included in this retrospective study. Patients were divided into 2 groups (n = 53, respectively): group 1 (first generation) and group 2 (second generation). Radiation dose for fluoroscopy and digital subtraction angiography (DSA) was compared between first-generation and second-generation angiography equipment, respectively. Among several features of the second-generation compared with the first-generation system, improvements included a refined crystalline detector system for enhanced noise reduction and advanced CARE filter software for lowering radiation dose. Radiation dose was measured using an ionization chamber. Image quality was assessed by 3 radiologists using 5-point Likert scales. Results: Both groups were comparable in terms of number and location of lesions, as well as body weight, body mass index, and anatomical variants of feeding hepatic arteries (all P > 0.05). Dose-area product (DAP) for fluoroscopy was significantly lower in group 2 (1.4 ± 1.1 Gy•cm 2 ) compared with group 1 (2.8 ± 3.4 Gy•cm 2 ; P = 0.001). For DSA, DAP was significantly lower (P = 0.003) in group 2 (2.2 ± 1.2 Gy•cm 2 ) versus group 1 (4.7 ± 2.3 Gy•cm 2 ). Scores for DSA IQ indicated significant improvements for group 2 by 30% compared with group 1 (P = 0.004). Regarding fluoroscopy, scores for IQ were 76% higher in group 2 compared with group 1 (P = 0.001). Good to excellent interrater agreement with Fleiss kappa coefficients of κ = 0.75 for group 1 and κ = 0.74 for group 2 were achieved. Conclusions: Most recent generation robotic angiography equipment allows for considerable radiation dose reductions while improving IQ in fluoroscopy and DSA image guidance during C-TACE treatment.

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confidence: 99%

Advanced Robotic Angiography Systems for Image Guidance During Conventional Transarterial Chemoembolization

et al. 2019

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“…LRT was associated with a statistically significant survival benefit even for delisted patients, with a median survival of 29.5 AE 8.4 months compared to 11 AE 5.1 months. 10 LRT was also associated with better survival in patients who received liver transplants, although this trend was not statistically significant, with a median survival of 63.4 AE 2.1 months compared to 59.5 AE 2.5 months. It should additionally be noted that patients in the LRT group did have higher initial tumor burden and spent a significantly longer time on the wait list than the group who did not undergo LRT prior to transplant, suggesting that bridging therapy can decrease likelihood of being delisted in higher risk patients.…”

Section: Bridging and Downstaging With Transarterial Therapymentioning

confidence: 90%

“…9 During this time, patients can progress and become ineligible for transplant. 10 If a patient is within Milan criteria at presentation, locoregional therapies (LRT)-including ablation, conventional transarterial chemoembolization (cTACE), and radioembolization with yttrium-90 microspheres ( 90 Y) -may also be used to prevent the patient from progressing until they are able to receive a transplant. This process is known as bridging to transplant and is currently recommended by the American Association for the Study of Liver Diseases if a patient is expected to spend more than 6 months on the transplant waitlist.…”

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confidence: 99%

The Role of Interventional Radiology in the Pretransplant Management of Hepatocellular Carcinoma and Portal Vein Thrombosis

Shmelev

Thornburg

2019

Dig Dis Interv

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Hepatocellular carcinoma (HCC) is the most common primary liver tumor and is currently the leading indication for liver transplantation in the United States. Liver transplantation may provide a curative option for patients with HCC, but some present outside of the transplant criteria. Additionally, as the criteria for liver transplant eligibility in HCC are expanded and the incidence of disease increases, waitlist times are becoming progressively longer, which increases the chance of a patient suffering from disease progression while awaiting an organ becoming ineligible for transplant. Multiple studies have demonstrated the successful use of locoregional therapies, including trans-arterial chemoembolization and trans-arterial radioembolization, in downstaging HCC to within transplant criteria, as well as in preventing progression of disease in patients already listed for transplant. Cirrhotic patients also commonly develop portal vein thrombosis (PVT), which is a contraindication to transplantation at many centers. PVT can lead to worsened outcomes after transplant depending on the type of portal venous reconstruction that is performed. The purpose of this article is to discuss the integral role of interventional radiology in the care of these patients, including the role of transarterial therapies in the pretransplant treatment of HCC and the use of endovascular techniques to recanalize thrombosed portal veins in order to establish or maintain transplant eligibility.

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“…The full-text articles of 128 papers were retrieved and assessed. Finally, six papers [24][25][26][27][28][29] (1043 patients) were included in the analysis (Figure 1), assessing the results of patients…”

Section: Literature Reviewmentioning

confidence: 99%

“…3.4 | Should patients with HCC within the listing criteria undergo a bridging therapy? (ITT outcomes of bridging therapies vs non-interventional strategy) (Table 2) 3.4.1 | Waiting list drop-out outcomes and interval on the waiting list Six studies [24][25][26][27][28][29] (1043 patients) reported on drop-out due to any cause, five 24,25,[27][28][29] on drop-out due to progression. Drop-out rate ranged from 2.9% to 33.8% in the bridging group, while it ranged from 8.6% to 24.1% in the non-interventional group.…”

Section: Patient Selection For Liver Transplantation and Bridging The...mentioning

confidence: 99%

Bridging therapies for patients with hepatocellular carcinoma awaiting liver transplantation: A systematic review and meta‐analysis on intention‐to‐treat outcomes

Martino

Ferraro

Pisaniello

et al. 2022

J Hepato Biliary Pancreat

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Introduction:Locoregional therapies are commonly used as bridging strategies to decrease the drop-out of patients with hepatocellular carcinoma (HCC) awaiting liver transplantation (LT). The present paper aims to assess the outcomes of bridging therapies in patients with HCC considered for LT according to an intention-to-treat (ITT) survival analysis. Material and methods: Medline and Web of Science databases were searched for reports published before May 2021. Papers assessing adult patients with HCC considered for LT and reporting ITT survival outcomes were included. Two reviewers independently identified, extracted the data, and evaluated the papers according to Newcastle-Ottawa criteria. Outcomes analyzed were: drop-out rate; time on the waiting list; 1-, 3-, and 5-year survival after LT and based on an ITT analysis. Results:The search identified 3106 records; six papers (1043 patients) met the inclusion criteria. Patients with HCC, listed for LT and submitted to bridging therapies presented a longer waiting time before LT (MD 3.77, 95% CI 2.07-5.48) in comparison with the non-interventional group. However, they presented a raised post LT after 1-year (OR 2.00, 95% CI 1.18-3.41), 3-years (OR 1.47, 95% CI 1.01-2.15), and 5-years (OR 1.50, 95% CI 1.06-2.13) survival. Conclusion:Patients submitted to bridging procedures, despite having a longer interval on the waiting list, presented better post-LT survival outcomes. Bridging therapies for selected patients at low risk of post-procedural complications and long expected intervals on the waiting list should be encouraged. However, further clinical trials should confirm the survival benefit of bridging therapies in patients with HCC listed for LT.

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The Impact of Bridging LRT on Survival in Patients Listed for Liver Transplantation

Abstract: Patients with HCC and the largest tumor greater than 30 mm treated with LRT prior to OLT have improved survival compared to patients not receiving LRT. Additionally, for patients who did not undergo transplant survival is significantly longer for those receiving LRT.

Cited by 6 publications

References 20 publications

Advanced Robotic Angiography Systems for Image Guidance During Conventional Transarterial Chemoembolization

Advanced Robotic Angiography Systems for Image Guidance During Conventional Transarterial Chemoembolization

The Role of Interventional Radiology in the Pretransplant Management of Hepatocellular Carcinoma and Portal Vein Thrombosis

Bridging therapies for patients with hepatocellular carcinoma awaiting liver transplantation: A systematic review and meta‐analysis on intention‐to‐treat outcomes

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