M. A. Selim1, M. Zimmerman1, J. Kim1, E. Hohenwalter2, W. Rilling2, J. C. Hong1 2Medical College Of Wisconsin,Department Of Radiology. Division Of Vascular And Intervention Radiology.,Milwaukee, WI, USA 1Medical College Of Wisconsin,Department Of Surgery. Division Of Transplant Surgery,Milwaukee, WI, USA
Introduction: Transarterial chemoembolization (TACE) is commonly utilized to downstage irresectable hepatic tumors prior to liver transplant (LT). Vascular complications of the hepatic artery (HA) after TACE may impact its suitability for vascular anastomosis during LT. We sought to examine HA quality in patients with pre-LT TACE.
Methods: We conducted a single center analysis from our prospective database of all adult LT performed in our center between October 2012 and May 2018. Median follow up was 26 months. Outcomes were compared between patients who received pre-LT TACE and those who did not.
Results: 162 transplants were included. Group I did not receive pre-LT TACE (n=110), Group II did (n=52). . Patients with TACE tended to be older males with viral hepatitis. Other characteristics are outlined in Table 1.
Our standard target for arterial anastomosis is the native common HA. For patients with TACE (Group II) only two cases (4%) required an aortic conduit to be created for arterialization because of inadequate CHA (dissection or poor vessel quality), compared to 8% in Group I, p=0.4.
The incidence of post-LT vascular complications was similar, Group I=6.3% and Group II=5.7% (p=0.9). Most complications were late (>30 days). Only one case in the TACE group was due to native HA dissection that necessitated revision and creating an aortic conduit.
Cox regression analysis showed that TACE wasn’t associated with increased risk of vascular complications. There was no difference in patient or graft survival between the two groups (p=0.1 and 0.2 respectively)
Conclusion: We found no association between TACE and higher rates of arterial vascular complications or other post-LT adverse outcomes. Careful post-LT follow up is important for early detection and management of any vascular complication.
