Locoregional therapy for hepatocellular carcinoma before transplant: Impact on tumor necrosis, tumor recurrence, and long-term survival.

579 Background: To assess the effectiveness of different pre-transplant loco-regional therapy (LRT) approaches in patients with hepatocellular carcinoma (HCC) by tumor necrosis in liver explants, predictors of post-liver transplantation (LT) HCC recurrence and overall survival after LT. Methods: A retro analysis on consecutive patients who received LRT for HCC, within and beyond Milan criteria, prior to LT over a 12-year period. Categorical and continuous variables were examined using one-way ANOVA, while correlations among continuous variables were evaluated using correlation analysis. Linear regression was utilized to identify predictive factors. Survival outcomes were analyzed using the Kaplan-Meier method, with differences assessed via the log-rank test. Additionally, multivariate regression analysis was performed to explore the association between categorical and continuous variables and the risk of post-transplant recurrence. Results: 165 patients with HCC treated with 233 LRT sessions (median 1, range 1-5) prior to LT; 125 (76%) within Milan and 40 (24%) downstaged outside Milan, 30 (18%) had microvascular invasion in explants. Kaplan-Meier analysis showed median OS was 127 months post LT; mean 96 ± 4 months. The overall explant tumor necrosis after LT was 86%. The overall tumor necrosis with TACE+ablation, Y90, ablation, and TACE were 92, 89.3, 85.4 and 71%, respectively (p0.05). Median OS was 127 months; mean 96 ± 4 months. Mean OS was 103 months (SD: 4, 95% CI: 95–111) for Milan In, and 92 months (SD: 9, 95% CI: 73–110) for Milan Out. Post-LT recurrence-free survival in patients treated with TACE+ablation and Y90 was ≥90% (p