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Background: Transplant candidacy in the setting of HCC is largely dependent on a patient falling within Milan criteria. For those who fall outside of Milan criteria or in regions where liver transplant (LT) waiting times are prolonged, locoregional therapies (LRT) are used to decrease tumor burden as a bridge to LT. There is limited amount of data available regarding the effects of LRT on peri-operative LT complications and outcomes. The aim of this study was to examine the effects of LRT for treatment of HCC on peri-operative LT outcomes. Methods: We conducted a retrospective review of patients who underwent LT from 2012 - 2018. Patients with cirrhosis and HCC who were transplanted within the study period and received LRT (drug eluting bead chemoembolization, thermal ablation, SBRT or yttrium-90 glass sphere radioembolization) for HCC prior to LT were compared to a control group of patients who did not receive LRT. Demographic variables and peri-operative data were collected for both groups. Univariate two-group comparisons were performed using 2-sample t-tests and wilcoxon rank sum tests. Results: 160 LRT patients were compared to 200 controls. Patients who received LRT prior to LT were older than the control group (60.95 vs. 56.47; p< 0.001). HCV was more common in the LRT group than controls (69% vs. 26%; p <.001). 11% of the LRT group and 21% of controls had cirrhosis due to alcohol (p<.001). Mean native MELD at time of LT was 23.57 and 25.56 (p = 0.005) for the LRT patients and control groups respectively. The control group had significantly greater intra- operative transfusion requirements and longer hospital stays than the LRT group. There were no significant differences in the occurrence of bile leak, anastomotic biliary stricture or hepatic artery stenosis, post-LT nor total operative time, need for take back to OR or overall post LT mortality between the LRT and control groups. On subgroup analysis we did not find an increase in complications based on type of LRT or number of LRT treatments received. However, the long-term post LT mortality rate was higher among those who received TARE compared to those who did not receive TARE (33% vs. 12%; p=0.015). Conclusion: We found that the occurrence of LRT for HCC prior to LT did not lead to increased intra-operative transfusion requirements, longer post-LT hospital stay, higher post-LT complications, longer operative times, increased rates of return to the OR or increased overall mortality compared to patients who did not undergo LRT prior to LT.





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