Impact of bridge therapy for hepatocellular carcinoma in patients submitted to liver transplantation: A Brazilian multicenter study - 02/02/25

Doi : 10.1016/j.liver.2025.100258

Julia Fadini Margon ^a,^b,^⁎ , Aline Lopes Chagas ^a,^b, Angelo A. Mattos ^c, Márcio A. Diniz ^d, Guilherme E.G. Felga ^e, Ilka F.S.F. Boin ^f, Renato Ferreira da Silva ^g, José Huygens Parente Garcia ^h, Agnaldo Soares Lima ⁱ, Rita C.M.A. da Silva ^g, Paulo Everton Garcia Costa ^h, Maria Lúcia Zanotelli ^j, Júlio Cezar Uili Coelho ^k, André L.C. Watanabe ^l, Débora Raquel Terrabuio ^a, Paulo Roberto Reichert ^m, Paulo Lisboa Bittencourt ⁿ, Leila M.M. Beltrão Pereira ^o,^p, Luiz Augusto Carneiro-D'Albuquerque ^b,^q, Flair José Carrilho ^a,^b
and
Brazilian HCC Study Group
^a Division of Clinical Gastroenterology and Hepatology, Hospital das Clínicas, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil
^b São Paulo Clinicas Liver Cancer Group, São Paulo, Brazil
^c Department of Gastroenterology, Fundação Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
^d Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
^e Liver Transplantation Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
^f Liver Transplantation Unit, State University of Campinas, Campinas, Brazil
^g Departamento de Clínica Médica e Unidade de Transplante de Fígado, Hospital de Base - FUNFARME, Faculdade de Medicina de São José do Rio Preto - FAMERP, São José do Rio Preto, Brazil
^h Ceará Unit of Liver Transplantation, Department of Surgery and Liver Transplantation, Federal University of Ceará, Fortaleza, Brazil
ⁱ Federal University of Minas Gerais School of Medicine, Belo Horizonte, Brazil
^j Liver Transplantation Group, Santa Casa de Misericórdia de Porto Alegre – ISCMPA, Porto Alegre, Brazil
^k Federal University of Parana, Surgery Department, Curitiba, Brazil
^l Liver Transplantation Group, Instituto de Cardiologia e Transplantes do Distrito Federal, Distrito Federal, Brazil
^m Liver Transplantation Group, Hospital São Vicente de Paulo Passo Fundo, Passo Fundo, Brazil
ⁿ Department of Gastroenterology and Hepatology, Portuguese Hospital of Salvador, Brazil
^o Department of Gastroenterology, Faculty of Medicine, University of Pernambuco, Recife, Brazil
^p Liver Institute of Pernambuco, Recife, Brazil
^q Digestive Organs Transplant Division. Hospital das Clínicas, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil

^⁎Corresponding author.Teodoro Sampaio Street, number 498, apartment 12405406-000Brazil

connectez-vous ou créez un compte

Bienvenue sur EM-consulte, la référence des professionnels de santé.
Article gratuit.

Connectez-vous pour en bénéficier!

Highlights

•	This large multicenter study evaluates the impact of bridge therapy on post-transplant outcomes.
•	A waiting time on transplant list was longer than 6 months in half of patients.
•	67 % received bridge therapy and transarterial chemoembolization was the most common.
•	Complete response to bridge therapy was associated with lower tumor recurrence.
•	Objective response to treatment was an independent predictor of lower recurrence.

Le texte complet de cet article est disponible en PDF.

Abstract

Introduction and objectives

Hepatocellular carcinoma (HCC) is a main indication for liver transplantation (LT). Bridge therapy (BT) is recommended when waiting time on transplant list is longer than 6 months to prevent dropout. However, the prognostic role of locoregional treatment in post-LT outcomes needs to be better defined. Our aims were to evaluate the impact of BT on post-LT overall survival (OS) and recurrence-free survival (RFS) among LT recipients with HCC.

Materials and Methods

Multicenter retrospective cohort study in HCC patients submitted to LT with clinical and radiological data analysis. Clinical features, BT and tumor response according to mRECIST were analyzed. Post-LT OS and RFS according to this were compared.

Results

1,119 patients were included. Waiting time on transplant list was longer than 6 months in 49 % of patients and 67 % underwent BT. Transarterial-chemoembolization/embolization were the most common treatments performed (80 %). According to mRECIST, 37 % showed complete response (CR), 38 % partial response (PR), 12 % stable disease (SD) and 13 % progressive disease (PD). The OS was 63 % in 5y in a mean follow-up of 28 months. Post-LT tumor recurrence was 8 %. There were no differences in RFS or OS among patients who underwent or not BT. However, patients who achieved CR had a higher RFS compared to PR, SD or PD (p = 0.019) and the objective response to treatment was an independent predictor of lower recurrence risk.