Impact of bridge therapy for hepatocellular carcinoma in patients submitted to liver transplantation: A Brazilian multicenter study

Introduction and objectives: Hepatocellular carcinoma (HCC) is a main indication for liver transplantation (LT). Bridge therapy (BT) is recommended when waiting time on transplant list is longer than 6 months to prevent dropout. However, the prognostic role of locoregional treatment in post-LT outcomes needs to be better defined. Our aims were to evaluate the impact of BT on post-LT overall survival (OS) and recurrence-free survival (RFS) among LT recipients with HCC. Materials and Methods: Multicenter retrospective cohort study in HCC patients submitted to LT with clinical and radiological data analysis. Clinical features, BT and tumor response according to mRECIST were analyzed. Post-LT OS and RFS according to this were compared. Results: 1,119 patients were included. Waiting time on transplant list was longer than 6 months in 49 % of patients and 67 % underwent BT. Transarterial-chemoembolization/embolization were the most common treatments performed (80 %). According to mRECIST, 37 % showed complete response (CR), 38 % partial response (PR), 12 % stable disease (SD) and 13 % progressive disease (PD). The OS was 63 % in 5y in a mean follow-up of 28 months. Post-LT tumor recurrence was 8 %. There were no differences in RFS or OS among patients who underwent or not BT. However, patients who achieved CR had a higher RFS compared to PR, SD or PD (p = 0.019) and the objective response to treatment was an independent predictor of lower recurrence risk. Conclusions: In a large multicentric cohort of LT recipients we observed that patients that achieved CR after BT presented lower risk of post-LT tumor recurrence.