Liver transplantation versus watchful waiting in hepatocellular carcinoma patients with complete response to bridging therapy – a retrospective observational study

Markus Bo Schoenberg, Ursula Ehmer, Andreas Umgelter, Julian Nikolaus Bucher, Dominik Thomas Koch, Nikolaus Börner, Hanno Nieß, Gerald Denk, Enrico Narciso De Toni, Max Seidensticker, Joachim Andrassy, Martin Kurt Angele, Jens Werner, Markus Otto Guba

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

Bridging therapy to prevent progression on the waiting list can result in a sustained complete response (sCR). In some patients, the liver transplantation (LT) risk might exceed those of tumor recurrence. We thus evaluated whether a watchful waiting (CR-WW) strategy could be a feasible alternative to transplantation (CR-LT). We performed a retrospective analysis of overall survival (OS) and recurrence-free survival (RFS) of patients with a sCR (CR > 6 months). Permitted bridging included thermoablation, resection, and combinations of either with transarterial chemoembolization. Patients were divided into the intended treatment strategies CR-WW and CR-LT. 39 (18.40%) sCR patients from 212 were investigated. 22 patients were treated with a CR-LT and 17 patients a CR-WW strategy. Five-year RFS was lower in the CR-WW than in the CR-LT group [53.3% (22.1%; 77.0%) and 84.0% (57.6%; 94.7%)]. 29.4% (5/17) CR-WW patients received salvage transplantation because of recurrence. OS (5-year) was 83.9% [56.8%; 94.7%] after LT and 75.4% [39.8%; 91.7%] after WW. Our analysis shows that the intuitive decision made by our patients in agreement with their treating physicians for a watchful waiting strategy in sCR can be justified. Applied on a larger scale, this strategy could help to reduce the pressure on the donor pool.

Original languageEnglish
Pages (from-to)465-473
Number of pages9
JournalTransplant International
Volume34
Issue number3
DOIs
StatePublished - Mar 2021

Keywords

  • bridging therapy
  • liver transplantation
  • oncology
  • risk stratification
  • tumor biology

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