Clinical transplantation · 2018
The impact of transarterial chemoembolization induced complications on outcomes after liver transplantation: A propensity-matched study.
Клиническое исследованиеСтатьяНазвание и аннотация: Перевод пока не подготовлен
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Boteon Amanda Pinter Carvalheiro da Silva, Boteon Yuri Longatto, Vinuela Eduardo F, Derosas Carlos, Mergental Hynek, Isaac John R, Muiesan Paolo, Mehzard Homoyoon, Ma Yuk Ting, Shah Tahir, Mirza Darius F, Perera M Thamara P R
Аннотация
BACKGROUND: Loco-regional complications of transarterial chemoembolization (TACE) may adversely affect technical aspects of the liver transplantation (LT). This study reviewed the impact of those complications on postoperative outcomes encompassing implications on graft selection.
METHODS: A retrospective, propensity score matching (1:1) analysis accounting for donor and recipient confounders was performed on a dataset of patients undergoing LT for hepatocellular carcinoma. Outcomes of patients who had TACE (TACE-group) were compared with those who did not (NoTACE-group).
RESULTS: A total of 57 matched pairs were analyzed. TACE achieved effective tumor control (Pre-TACE vs Post-TACE; Median: 44 mm [interquartile range: 43-50] vs 17 mm [0-36]; P = .002) on imaging follow-up. TACE group had, at the hepatectomy, higher incidence of ischemia-related complications (adhesions of the necrotic tumor, cholecystitis, and/or bile duct necrosis) (40.4% vs 10.5%; P = .001). Overall major post-LT complications rate (Dindo-Clavien ≥3) were similar (P = .134). Those in the TACE group with donors after circulatory death (DCD) had 4.6% 90-day mortality and 54.3% major complication rate compared to 6.9% and 77.3% (P = .380 and P = .112, respectively).
CONCLUSION: TACE was an effective bridging procedure that may complicate LT inducing ischemic-related complications; nevertheless, it has not shown repercussions on mortality or morbidity after the procedure, even using donors after circulatory death.
METHODS: A retrospective, propensity score matching (1:1) analysis accounting for donor and recipient confounders was performed on a dataset of patients undergoing LT for hepatocellular carcinoma. Outcomes of patients who had TACE (TACE-group) were compared with those who did not (NoTACE-group).
RESULTS: A total of 57 matched pairs were analyzed. TACE achieved effective tumor control (Pre-TACE vs Post-TACE; Median: 44 mm [interquartile range: 43-50] vs 17 mm [0-36]; P = .002) on imaging follow-up. TACE group had, at the hepatectomy, higher incidence of ischemia-related complications (adhesions of the necrotic tumor, cholecystitis, and/or bile duct necrosis) (40.4% vs 10.5%; P = .001). Overall major post-LT complications rate (Dindo-Clavien ≥3) were similar (P = .134). Those in the TACE group with donors after circulatory death (DCD) had 4.6% 90-day mortality and 54.3% major complication rate compared to 6.9% and 77.3% (P = .380 and P = .112, respectively).
CONCLUSION: TACE was an effective bridging procedure that may complicate LT inducing ischemic-related complications; nevertheless, it has not shown repercussions on mortality or morbidity after the procedure, even using donors after circulatory death.
Предметные рубрики MeSH
Carcinoma, HepatocellularChemoembolization, TherapeuticFemaleFollow-Up StudiesGraft RejectionGraft SurvivalHepatectomyHumansLiver NeoplasmsLiver TransplantationMaleMiddle AgedNeoplasm Recurrence, LocalPostoperative ComplicationsPropensity ScoreRetrospective StudiesRisk FactorsSurvival RateTreatment Outcome