• Achuthan Sourianarayanane, Galal El-Gazzaz, Juan R Sanabria, K V Narayanan Menon, Cristiano Quintini, Koji Hashimoto, Dympna Kelly, Bijan Eghtesad, Charles Miller, John Fung, and Federico Aucejo.
• Departments of Gastroenterology and Hepatology Transplant Surgery, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA. souriaa@ccf.org
• HPB (Oxford). 2012 May 1;14(5):325-32.

ObjectivesLiver transplantation (LT) in Milan Criteria (MC) hepatocellular carcinoma (HCC) has excellent outcomes. Pre-transplant loco-regional therapy (LRT) has been used to downstage HCC to meet the MC. However, its benefit in patients with a brief waiting time to transplant remains unclear. This study evaluated outcomes in patients with short waitlist times to LT for MC-compliant HCC.MethodsPatients undergoing LT for MC HCC at either of two transplant centres between 2002 and 2009 were retrospectively evaluated for outcome. Patients for whom post-transplant follow-up amounted to <12 months were excluded.ResultsA total of 225 patients were included, 93 (41.3%) of whom received neoadjuvant LRT. The median waiting time to transplant was 48 days. Mean post-transplant follow-up was 32.2 months. Overall and disease-free survival at 1 year, 3 years and 5 years were 93.1%, 82.4% and 72.6%, and 91.3%, 79.3% and 70.6%, respectively. There was no difference in overall (P= 0.94) and disease-free survival (P= 0.94) between groups who received and did not receive pre-LT LRT. There were also no disparities in survival or tumour recurrence among categories of patients (with single tumours measuring <3 cm, with single tumours measuring 3-5 cm, with multiple tumours).ConclusionsLoco-regional therapy followed by rapid transplantation in MC HCC appears not to have an impact on post-transplant outcome.© 2012 International Hepato-Pancreato-Biliary Association.

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