O-4 IMPACT OF BRIDGE THERAPY FOR HEPATOCELLULAR CARCINOMA IN PATIENTS SUBMITTED TO LIVER TRANSPLANTATION - BRAZILIAN MULTICENTER STUDY

Margon, Julia Fadini; Chagas, Aline Lopes; Mattos, Angelo A.; Diniz, Márcio Augusto; Gonçalves Felga, Guilherme Eduardo; Boin, Ilka de Fátima Santana Ferreira; da Silva, Rita de Cássia Martins Alves; da Silva, Renato Ferreira; Garcia, José Huygens Parente; Lima, Agnaldo Soares; Coelho, Júlio Cezar Uili; Bittencourt, Paulo Lisboa; Ferreira Alves, Venâncio Avancini; Carneiro D'Albuquerque, Luiz Augusto; Carrilho, Flair José

doi:10.1016/j.aohep.2021.100491

ISSN: 1665-2681

Annals of Hepatology (AoH) is an international, open access journal published bi-monthly with funds from the Fundación Clínica Médica Sur. It is the official journal of the Mexican Association of Hepatology (AMH), the Latin American Association for the Study of the Liver (ALEH), the Canadian Association for the Study of the Liver (CASL) and the Czech Society of Hepatology (CSH). AoH publishes editorials, opinions, concise reviews, original articles, brief reports, letters to the editor, news from affiliated associations, clinical practice guidelines and summaries of congresses in the field of Hepatology.

Topics covered by AoH include alcoholic liver disease, autoimmune hepatitis, biliary diseases, drug-induced liver injury, genetic liver diseases, NAFLD/NASH and viral hepatitis (HAV, HBV, HCV, HDV, HEV). Our journal seeks to publish articles on basic clinical care and translational research focused on preventing rather than treating the complications of end-stage liver disease.

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Julia Fadini Margon1,2, Aline Lopes Chagas1,2, Angelo A. Mattos3, Márcio Augusto Diniz4, Guilherme Eduardo Gonçalves Felga5, Ilka de Fátima Santana Ferreira Boin6, Rita de Cássia Martins Alves da Silva7, Renato Ferreira da Silva8, José Huygens Parente Garcia9, Agnaldo Soares Lima10, Júlio Cezar Uili Coelho11, Paulo Lisboa Bittencourt12, Venâncio Avancini Ferreira Alves2,13, Luiz Augusto Carneiro D'Albuquerque2,14, Flair José Carrilho1,2, Brazilian HCC Study Group

1 Division of Clinical Gastroenterology and Hepatology, Hospital das Clínicas, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil

2 São Paulo Clinicas Liver Cancer Group, São Paulo, Brazil

3 Department of Gastroenterology and Hepatology, Fundação Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil

4 Biostatistics and Bioinformatics Research Center, Cedars Sinai Medical Center, Los Angeles, United States

5 Liver Transplantation Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil

6 Liver Transplantation Unit, State University of Campinas, Campinas, Brazil

7 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

8 Departamento de Cirugía 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

9 Ceará Unit of Liver Transplantation, Department of Surgery and Liver Transplantation, Federal University of Ceará, Fortaleza, Brazil

10 Federal University of Minas Gerais School of Medicine, Belo Horizonte

11 Federal University of Parana, Surgery Department, Curitiba, Brazil

12 Department of Gastroenterology and Hepatology, Portuguese Hospital of Salvador, Bahia, Brazil

13 Department of Pathology, University of São Paulo School of Medicine, São Paulo, Brazil

14 Digestive Organs Transplant Division. Hospital das Cínicas, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil

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Special issue

This article is part of special issue:

Vol. 24. Issue S1

Abstracts of the 2021 Annual meeting of the ALEH (Asociación Latinoamericana para el Estudio del Hígado)

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Background

Hepatocellular carcinoma (HCC) is one of the main indications for liver transplantation (LT). Bridge therapy (BT) is recommended when waiting time on transplant list is longer than six months to avoid tumor progression and dropout. Response to locoregional treatment has been considered as a good prognostic parameter in post-LT, however, its role still needs to be defined.

Aims

To evaluate the role of BT for HCC on survival and post-LT tumor recurrence.

Methods

Brazilian multicenter retrospective cohort study in HCC patients submitted to LT with clinical and radiological data analysis. Data related to HCC pre-LT treatment, type of treatment and the final response according to mRECIST criteria in the last pre-LT image exam were analyzed. Survival curves were presented using the Kaplan-Meier and compared using the log-rank test.

Results

1,119 patients were included. 81% were males and mean age at LT was 58 ± 8.2 years. At HCC diagnosis, 85% were within Milan criteria (MC) by imaging studies and 67%, underwent BT prior to LT. TACE/TAE were performed in 80%, PEI 9%, RFA 3%, surgery 1% and combined therapy 7%. According to mRECIST, 37% showed complete response (CR), 38% partial response (PR), 12% stable disease (SD) and 13% progressive disease (PD) after BT. The overall survival (OS) was 63% in 5 years, with a mean follow-up of 28 months. The post-LT tumor recurrence was 8%. There was no difference in the risk of post-LT tumor recurrence or survival among patients who underwent BT or not or between the various types of treatment performed. However, patients who have CR to BT had a higher recurrence-free survival compared to patients with PR, SD or PD (p = 0.019).

Conclusions

This study demonstrated the role of BT in LT, since patients with complete response, had a lower risk of post-transplant tumor recurrence.

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