- Email: [email protected]
Clinicopathologic factors predicting hepatocellular carcinoma recurrence in patients receiving bridging locoregional therapy for orthotopic liver transplantation: a 15-year experience
S124
’
Wednesday
Scientific Session
patients with HO on EB (3/7 good, 4/7 bad) and no HO on EB (2/3 good, 1/3 bad) had mixed outcomes (see table). In patients without biopsy post-PTA (8/21), 6/8 had bad and 2/8 had good outcomes.There was no significant difference (p 40.05) in time between transplant and PTA, improvement in luminal diameter or manometry (pre- vs. post-PTA) in patients with good vs. bad outcomes, and patients with HO vs. no HO on EB or on LB. Conclusion: Liver biopsy is an important diagnostic and prognostic tool in transplant patients needing PTA for HO. Biopsy 460d (rather than early biopsy) after PTA accurately separates patients with good long-term clinical outcomes from patients with persistent HO requiring further interventions.
JVIR
Thrombolysis may have a limited role in the management of HAT in the post-transplant population.
2:42 PM
Abstract No. 266
Clinicopathologic factors predicting hepatocellular carcinoma recurrence in patients receiving bridging locoregional therapy for orthotopic liver transplantation: a 15-year experience
D.S. Shin1, S.A. Padia1, S.W. Kwan1, D.S. Hippe1, K. Valji1, M. Kogut1,2; 1University of Washington, Seattle, WA; 2VA Puget Sound, Seattle, WA
M. Xing1,2, R. Dhanasekaran1, N. Kokabi1, J.C. Camacho1, S. Parekh2, S.J. Knechtle2,5, V. Adsay4, J.R. Spivey2, H.S. Kim1,3; 1Interventional Radiology and Image-Guided Medicine, Department of Radiology, Emory University School of Medicine, Atlanta, GA; 2Division of Digestive Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA; 3Division of Interventional Radiology, Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA; 4Department of Anatomic Pathology, Emory University School of Medicine, Atlanta, GA; 5Department of Surgery, Emory University School of Medicine, Atlanta, GA
Purpose: Hepatic artery thrombosis (HAT) represents a major cause of graft failure and death following liver transplantation. Catheter-directed thrombolysis is a potential alternative management option to surgical revascularization. This study evaluates the safety and efficacy of thrombolysis. Materials and Methods: Adult liver transplant recipients who underwent attempted thrombolysis for HAT from 2000-13 were identified. A retrospective review of imaging and electronic medical records was performed to determine the rates of technical success, complication, and clinical outcomes including surgical revision, retransplant, and ischemic cholangiopathy. Results: 26 patients presented for attempted thrombolysis, of whom 13 were within 30 days of transplant (early HAT). Thrombolysis could not be initiated in 3 due to complications or inability to penetrate the thrombus. 23 patients underwent intraarterial thrombolysis (22 tPA; 1 urokinase) for a median of 28 hours (range 12-90). Successful recanalization was achieved in 12 (46%). Major complications were observed in 11 (42%): hepatic artery dissection in 4 of 26 (15%); access site bleeding requiring transfusion in 2 of 23 who underwent thrombolysis (9%); and intraabdominal bleeding requiring transfusion and/or exploratory laparotomy in 5 of 23 (22%). The early HAT group showed a trend toward increased major bleeding rate compared to the late HAT group (50 vs. 9%; p¼0.07) despite significantly shorter thrombolysis duration (median 24 vs. 43 hours; p¼0.02). Among 12 patients with successful thrombolysis, 5 (42%) still required surgical revascularization or retransplantation within 2 months. At 6 months after thrombolysis, only 5 of 12 (42%) with successful thrombolysis avoided additional interventions related to HAT and ischemic cholangiopathy, which was similar to the proportion observed in the failed thrombolysis group (5/11, 45%; p¼0.8). Conclusion: Technical success of thrombolysis for HAT was suboptimal with a high complication rate. Even in the setting of technically successful thrombolysis, clinical outcomes were poor and similar to patients with failed thrombolysis.
Purpose: To investigate the incidence of hepatocellular carcinoma (HCC) recurrence after orthotopic liver transplant (OLT) for HCC in patients treated with bridging locoregional therapy (LRT), and to identify factors predicting HCC recurrence. Materials and Methods: Under IRB approval, our transplant center registry was queried for patients with HCC within the Milan Criteria who underwent OLT from June 1998 to September 2013. Baseline clinical data, liver explant histopathological characteristics including tumor grade, degree of necrosis and microvascular invasion, and HCC recurrence rates for patients who received pre-OLT bridging LRT were compared to those who did not. Tumor histopathological characteristics were assessed from liver explants. Chi-squared test was used to compare categorical variables and paired t-test was used to compare continuous variables, with significance set at po0.05. Results: A total of 205 patients were included; 59% (111/205, Group A) received bridging LRT and 41% (94/205, Group B) did not. Both groups were similar for age at diagnosis, gender, race, lobar involvement, HCC etiology, and mean largest tumor size (po0.05). Mean follow-up duration post-OLT was 6.3 years. The overall post-OLT HCC recurrence rate was 5.4% (11/205), with 3.6% (4/111) recurrence in Group A and 7.4% (7/94) in Group B (p¼0.02). Eight patients in Group A demonstrated 100% explant necrosis and histopathology could not be analyzed. Of the remaining 197 patients, 11.2% (22/197) had microvascular invasion on explant pathology. The HCC recurrence rate in patients with microvascular invasion was 22.7% (5/22), compared to 3.4% (6/175) in patients without microvascular invasion (p¼0.001). Overall, 58 (29.4%), 101 (51.3%) and 38 (19.3%) patients had tumor grades 1, 2 and 3, respectively. The incidence of HCC recurrence was 3.8% (6/ 159) in patients with tumor grade 1 or 2 on explant, compared to 13.2% (5/38) in patients with grade 3 tumor (p¼0.01). Conclusion: Bridging LRT correlated with significantly lower HCC recurrence following OLT for HCC. The presence of
2:33 PM
Abstract No. 265
Catheter-directed thrombolysis for hepatic artery thrombosis following liver transplantation
WEDNESDAY: Scientific Sessions
’
’
Wednesday
Scientific Session
patients with HO on EB (3/7 good, 4/7 bad) and no HO on EB (2/3 good, 1/3 bad) had mixed outcomes (see table). In patients without biopsy post-PTA (8/21), 6/8 had bad and 2/8 had good outcomes.There was no significant difference (p 40.05) in time between transplant and PTA, improvement in luminal diameter or manometry (pre- vs. post-PTA) in patients with good vs. bad outcomes, and patients with HO vs. no HO on EB or on LB. Conclusion: Liver biopsy is an important diagnostic and prognostic tool in transplant patients needing PTA for HO. Biopsy 460d (rather than early biopsy) after PTA accurately separates patients with good long-term clinical outcomes from patients with persistent HO requiring further interventions.
JVIR
Thrombolysis may have a limited role in the management of HAT in the post-transplant population.
2:42 PM
Abstract No. 266
Clinicopathologic factors predicting hepatocellular carcinoma recurrence in patients receiving bridging locoregional therapy for orthotopic liver transplantation: a 15-year experience
D.S. Shin1, S.A. Padia1, S.W. Kwan1, D.S. Hippe1, K. Valji1, M. Kogut1,2; 1University of Washington, Seattle, WA; 2VA Puget Sound, Seattle, WA
M. Xing1,2, R. Dhanasekaran1, N. Kokabi1, J.C. Camacho1, S. Parekh2, S.J. Knechtle2,5, V. Adsay4, J.R. Spivey2, H.S. Kim1,3; 1Interventional Radiology and Image-Guided Medicine, Department of Radiology, Emory University School of Medicine, Atlanta, GA; 2Division of Digestive Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA; 3Division of Interventional Radiology, Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA; 4Department of Anatomic Pathology, Emory University School of Medicine, Atlanta, GA; 5Department of Surgery, Emory University School of Medicine, Atlanta, GA
Purpose: Hepatic artery thrombosis (HAT) represents a major cause of graft failure and death following liver transplantation. Catheter-directed thrombolysis is a potential alternative management option to surgical revascularization. This study evaluates the safety and efficacy of thrombolysis. Materials and Methods: Adult liver transplant recipients who underwent attempted thrombolysis for HAT from 2000-13 were identified. A retrospective review of imaging and electronic medical records was performed to determine the rates of technical success, complication, and clinical outcomes including surgical revision, retransplant, and ischemic cholangiopathy. Results: 26 patients presented for attempted thrombolysis, of whom 13 were within 30 days of transplant (early HAT). Thrombolysis could not be initiated in 3 due to complications or inability to penetrate the thrombus. 23 patients underwent intraarterial thrombolysis (22 tPA; 1 urokinase) for a median of 28 hours (range 12-90). Successful recanalization was achieved in 12 (46%). Major complications were observed in 11 (42%): hepatic artery dissection in 4 of 26 (15%); access site bleeding requiring transfusion in 2 of 23 who underwent thrombolysis (9%); and intraabdominal bleeding requiring transfusion and/or exploratory laparotomy in 5 of 23 (22%). The early HAT group showed a trend toward increased major bleeding rate compared to the late HAT group (50 vs. 9%; p¼0.07) despite significantly shorter thrombolysis duration (median 24 vs. 43 hours; p¼0.02). Among 12 patients with successful thrombolysis, 5 (42%) still required surgical revascularization or retransplantation within 2 months. At 6 months after thrombolysis, only 5 of 12 (42%) with successful thrombolysis avoided additional interventions related to HAT and ischemic cholangiopathy, which was similar to the proportion observed in the failed thrombolysis group (5/11, 45%; p¼0.8). Conclusion: Technical success of thrombolysis for HAT was suboptimal with a high complication rate. Even in the setting of technically successful thrombolysis, clinical outcomes were poor and similar to patients with failed thrombolysis.
Purpose: To investigate the incidence of hepatocellular carcinoma (HCC) recurrence after orthotopic liver transplant (OLT) for HCC in patients treated with bridging locoregional therapy (LRT), and to identify factors predicting HCC recurrence. Materials and Methods: Under IRB approval, our transplant center registry was queried for patients with HCC within the Milan Criteria who underwent OLT from June 1998 to September 2013. Baseline clinical data, liver explant histopathological characteristics including tumor grade, degree of necrosis and microvascular invasion, and HCC recurrence rates for patients who received pre-OLT bridging LRT were compared to those who did not. Tumor histopathological characteristics were assessed from liver explants. Chi-squared test was used to compare categorical variables and paired t-test was used to compare continuous variables, with significance set at po0.05. Results: A total of 205 patients were included; 59% (111/205, Group A) received bridging LRT and 41% (94/205, Group B) did not. Both groups were similar for age at diagnosis, gender, race, lobar involvement, HCC etiology, and mean largest tumor size (po0.05). Mean follow-up duration post-OLT was 6.3 years. The overall post-OLT HCC recurrence rate was 5.4% (11/205), with 3.6% (4/111) recurrence in Group A and 7.4% (7/94) in Group B (p¼0.02). Eight patients in Group A demonstrated 100% explant necrosis and histopathology could not be analyzed. Of the remaining 197 patients, 11.2% (22/197) had microvascular invasion on explant pathology. The HCC recurrence rate in patients with microvascular invasion was 22.7% (5/22), compared to 3.4% (6/175) in patients without microvascular invasion (p¼0.001). Overall, 58 (29.4%), 101 (51.3%) and 38 (19.3%) patients had tumor grades 1, 2 and 3, respectively. The incidence of HCC recurrence was 3.8% (6/ 159) in patients with tumor grade 1 or 2 on explant, compared to 13.2% (5/38) in patients with grade 3 tumor (p¼0.01). Conclusion: Bridging LRT correlated with significantly lower HCC recurrence following OLT for HCC. The presence of
2:33 PM
Abstract No. 265
Catheter-directed thrombolysis for hepatic artery thrombosis following liver transplantation
WEDNESDAY: Scientific Sessions
’