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

Abstract

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.