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Association Between Bridging Therapy And Posttransplant Outcomes In Patients With Hcc Within Milan Criteria: A Systematic Review And Meta-analysis.

Home
Research Domains
Biomedical And Clinical Sciences
Oncology And Carcinogenesis
Predictive And Prognostic Markers
Association Between Bridging Therapy And Posttransplant Outcomes In Patients With Hcc Within Milan Criteria: A Systematic Review And Meta-analysis.

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Association between bridging therapy and posttransplant outcomes in patients with HCC within Milan criteria: A systematic review and meta-analysis.

Ashwini Arvind¹, Karim Seif El Dahan¹, Riya Malhotra¹

¹Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA.

Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society

|March 11, 2024

View abstract on PubMed

Summary

This summary is machine-generated.

Bridging therapy before liver transplantation for hepatocellular carcinoma (HCC) does not improve survival outcomes. The decision to use bridging therapy should consider the individual patient's risk of waitlist dropout.

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Area of Science:

Hepatology and Transplant Surgery
Oncology Research
Evidence-Based Medicine

Background:

Liver transplantation is the primary curative treatment for early-stage hepatocellular carcinoma (HCC).
Locoregional therapies are frequently used as bridging treatments to prevent patients from dropping out of the transplant waitlist.
The impact of these bridging therapies on post-transplant survival remains uncertain.

Approach:

A systematic review of studies published from database inception to August 2, 2023, was conducted using Ovid MEDLINE and EMBASE.
The review focused on post-transplant recurrence-free survival and overall survival in HCC patients within Milan criteria, stratified by bridging therapy receipt.
Pooled hazard ratios (HRs) were calculated using a random-effects model.

Key Points:

The analysis included 38 studies with 19,671 patients receiving bridging therapy and 20,148 not receiving it.
Bridging therapy showed no significant association with improved recurrence-free survival (HR: 0.91) or overall survival (HR: 1.09).
Potential benefits were diminished with three or more bridging treatments; adverse events occurred in 6-15% of patients.

Conclusions:

Bridging therapy does not enhance post-transplant recurrence-free or overall survival for HCC patients meeting Milan criteria.
The risk-benefit balance of bridging therapy is influenced by the risk of waitlist dropout.
Further research may be needed to clarify optimal patient selection for bridging interventions.