Liver transplant mortality and morbidity following preoperative radiotherapy for hepatocellular carcinoma

Shaakir Hasan, Stephen Abel, Tadahiro Uemura, Vivek Verma, Eugene J. Koay, Joseph Herman, Ngoc Thai, Alexander Kirichenko

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

Abstract

Background: Radiotherapy (RT) can be used for tumor downstaging and as a bridge to transplantation in hepatocellular carcinoma (HCC), but its effect on surgical complications is unknown. Therefore, we investigated post-transplant mortality and acute readmission rates in HCC with and without preoperative RT using the National Cancer Database (NCDB). Methods: After exclusion, 11,091 transplant patients were analyzed, 165 of whom received RT prior to transplant. Multivariable binomial logistic regression analysis identified characteristics associated with use of RT, and factors associated with increased 30/90-day mortality and 30-day readmission, following propensity matching. Results: Although RT (median 40 Gy in 5 fractions) was more often delivered to larger tumors and advanced stages, it resulted in 59% downstaging rate, 39% pathologic complete response rate, and a median of 4 additional months to transplantation. Crude 30/90-day mortality rates were both 1.2% with preoperative RT, compared to 2.7% and 4.4% without. The 30-day readmission rate was 5.5% with RT and 10.7% without it. Propensity matched analysis demonstrated no statistical differences in 30/90-day mortality and a lower 30-day readmission rate with preoperative RT. Age >58, stage III disease, lack of transarterial chemoembolization, and shorter time to transplant independently predicted higher 90-day mortality. Conclusion: Preoperative RT for HCC did not increase postoperative mortality or length of stay following liver transplant.

Original languageEnglish (US)
Pages (from-to)770-778
Number of pages9
JournalHPB
Volume22
Issue number5
DOIs
StatePublished - May 2020

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

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