• D Wallace, T E Cowling, K Walker, A Suddle, A Gimson, I Rowe, C Callaghan, G Sapisochin, N Mehta, N Heaton, and J van der Meulen.
• Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.
• Br J Surg. 2020 Aug 1; 107 (9): 1183-1191.

BackgroundTransarterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC) awaiting liver transplantation is widespread, although evidence that it improves outcomes is lacking and there exist concerns about morbidity. The impact of TACE on outcomes after transplantation was evaluated in this study.MethodsPatients with HCC who had liver transplantation in the UK were identified, and stratified according to whether they received TACE between 2006 and 2016. Cox regression methods were used to estimate hazard ratios (HRs) for death and graft failure after transplantation adjusted for donor and recipient characteristics.ResultsIn total, 385 of 968 patients (39·8 per cent) received TACE. Five-year patient survival after transplantation was similar in those who had or had not received TACE: 75·2 (95 per cent c.i. 68·8 to 80·5) and 75·0 (70·5 to 78·8) per cent respectively. After adjustment for donor and recipient characteristics, there were no differences in mortality (HR 0·96, 95 per cent c.i. 0·67 to 1·38; P = 0·821) or graft failure (HR 1·01, 0·73 to 1·40; P = 0·964). The number of TACE treatments (2 or more versus 1: HR 0·97, 0·61 to 1·55; P = 0·903) or the time of death after transplantation (within or after 90 days; P = 0·291) did not alter the outcome. The incidence of hepatic artery thrombosis was low in those who had or had not received TACE (1·3 and 2·4 per cent respectively; P = 0·235).ConclusionTACE delivered to patients with HCC before liver transplant did not affect complications, patient death or graft failure after transplantation.© 2020 BJS Society Ltd Published by John Wiley & Sons Ltd.

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