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Feasibility and outcomes of percutaneous thermal ablation of hepatocellular carcinoma in a transplanted allograft

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Abstract

Purpose

To examine the safety, feasibility, and oncologic control following percutaneous image-guided thermal ablation of hepatocellular carcinoma (HCC) in a transplanted allograft.

Materials and Methods

Retrospective review was performed to identify patients who underwent liver transplantation for HCC and subsequently underwent percutaneous hepatic thermal ablation for recurrent HCC within the allograft between January 1st, 2000-September 1st, 2016. Eleven patients with hepatic allograft HCC underwent twelve percutaneous thermal ablation procedures to treat 16 lesions. Patient, procedural characteristics, and local oncologic efficacy were reviewed. Complications were characterized via the Common Terminology for Clinically Adverse Events nomenclature [CTCAE] v4.03).

Results

Eleven transplant recipients underwent treatment of 16 HCC tumors in their allografts during 12 ablation sessions. Mean follow-up time was 25 months (range 2–96 months). Local oncologic control was achieved in 10 of 11 tumors (91%) with imaging follow-up. One patient (8%) with Roux-en-Y biliary reconstruction developed a major complication with hepatic abscess.

Conclusion

Thermal ablation of recurrent HCC in transplanted allografts can be accomplished safely with acceptable rates of local control for patients with duct-to-duct biliary reconstruction. Due to the high number of patients deemed surgically unresectable, the morbidity of surgical resection, the side effects of targeted therapies, and significant mortality associated with recurrences in the transplanted allograft, patients may benefit from percutaneous thermal ablative treatments. Further study is needed to assess the role of thermal ablation in allograft HCC recurrences as primary therapy or in a multimodality approach with emerging systemic therapies.

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References

  1. Clavien PA, et al. (2012) Recommendations for liver transplantation for hepatocellular carcinoma: an international consensus conference report. Lancet Oncol 13(1):e11–e22

    Article  PubMed  Google Scholar 

  2. de’Angelis N, et al. (2015) Managements of recurrent hepatocellular carcinoma after liver transplantation: a systematic review. World J Gastroenterol 21(39):11185–11198

    Article  PubMed  PubMed Central  Google Scholar 

  3. Mazzaferro V, et al. (1996) Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med 334(11):693–699

    Article  CAS  PubMed  Google Scholar 

  4. Rubin J, et al. (2012) Management of recurrent hepatocellular carcinoma in liver transplant recipients: a systematic review. Exp Clin Transplant 10(6):531–543

    Article  PubMed  Google Scholar 

  5. Schwartz M (2004) Liver transplantation for hepatocellular carcinoma. Gastroenterology 127(5 Suppl 1):S268–S276

    Article  PubMed  Google Scholar 

  6. Yao FY, et al. (2002) Liver transplantation for hepatocellular carcinoma: comparison of the proposed UCSF criteria with the Milan criteria and the Pittsburgh modified TNM criteria. Liver Transplant 8(9):765–774

    Article  Google Scholar 

  7. Clark ME, Smith RR (2014) Liver-directed therapies in metastatic colorectal cancer. J Gastrointest Oncol 5(5):374–387

    PubMed  PubMed Central  Google Scholar 

  8. de Baere T, et al. (2003) Adverse events during radiofrequency treatment of 582 hepatic tumors. AJR 181(3):695–700

    Article  PubMed  Google Scholar 

  9. Foltz G (2014) Image-guided percutaneous ablation of hepatic malignancies. Semin Interventional Radiol 31(2):180–186

    Article  Google Scholar 

  10. Murata S, et al. (2014) Interventional treatment for unresectable hepatocellular carcinoma. World J Gastroenterol 20(37):13453–13465

    Article  PubMed  PubMed Central  Google Scholar 

  11. Saied A, Katz SC, Espat NJ (2013) Regional hepatic therapies: an important component in the management of colorectal cancer liver metastases. Hepatobiliary Surg Nutr 2(2):97–107

    PubMed  PubMed Central  Google Scholar 

  12. Solbiati L, et al. (2012) Small liver colorectal metastases treated with percutaneous radiofrequency ablation: local response rate and long-term survival with up to 10-year follow-up. Radiology 265(3):958–968

    Article  PubMed  Google Scholar 

  13. Sucandy I, et al. (2016) Longterm survival outcomes of patients undergoing treatment with radiofrequency ablation for hepatocellular carcinoma and metastatic colorectal cancer liver tumors. HPB 18(9):756–763 ((Oxford))

    Article  PubMed  PubMed Central  Google Scholar 

  14. Gringeri E, et al. (2014) Laparoscopic microwave thermal ablation for late recurrence of local hepatocellular carcinoma after liver transplant: case report. Prog Transplant 24(2):142–145

    Article  PubMed  Google Scholar 

  15. Ho CK, Chapman WC, Brown DB (2007) Radiofrequency ablation of recurrent hepatocellular carcinoma in a patient after liver transplantation: two-year follow-up. J Vasc Interv Radiol 18(11):1451–1453

    Article  PubMed  Google Scholar 

  16. Choi D, et al. (2005) Liver abscess after percutaneous radiofrequency ablation for hepatocellular carcinomas: frequency and risk factors. AJR 184(6):1860–1867

    Article  PubMed  Google Scholar 

  17. Elias D, et al. (2006) Liver abscess after radiofrequency ablation of tumors in patients with a biliary tract procedure. Clin Biol Gastroenterol 30(6–7):823–827

    Article  Google Scholar 

  18. Fonseca AZ, et al. (2014) Complications of radiofrequency ablation of hepatic tumors: frequency and risk factors. World J Hepatol 6(3):107–113

    Article  PubMed  PubMed Central  Google Scholar 

  19. Iida H, et al. (2014) Risk of abscess formation after liver tumor radiofrequency ablation: a review of 8 cases wtih a history of enterobiliary anastomosis. Hepato 61(135):1867–1870

    Google Scholar 

  20. Odisio BC, et al. (2016) Use of prophylactic antibiotics to prevent abscess formation following hepatic ablation in patients with prior enterobiliary manipulation. J Gastrointest Surg 20(8):1428–1434

    Article  PubMed  PubMed Central  Google Scholar 

  21. Shibata T, et al. (2003) Cholangitis and liver abscess after percutaneous ablation therapy for liver tumors: incidence and risk factors. J Vasc Interv Radiol 14(12):1535–1542

    Article  PubMed  Google Scholar 

  22. Welch BT, et al. (2017) Evaluation of infectious complications following percutaneous liver ablation in patients with bilioenteric anastomoses. Abdom Radiol 42(5):1579–1582 ((NY))

    Article  CAS  Google Scholar 

  23. Atwell TD, et al. (2010) Percutaneous renal cryoablation: local control at mean 26 months of followup. J Urol 184(4):1291–1295

    Article  PubMed  Google Scholar 

  24. Welch BT, et al. (2014) A single-institution experience in image-guided thermal ablation of adrenal gland metastases. J Vasc Interv Radiol 25(4):593–598

    Article  PubMed  Google Scholar 

  25. Welch BT, et al. (2014) Feasibility and oncologic control following percutaneous image-guided ablation of metastatic renal cell carcinoma. J Urol 192(2):357–363

    Article  PubMed  Google Scholar 

  26. National Cancer Institute (2009) Common terminology criteria for adverse events (CTCAE) version 4.0. National Institutes of Health, National Cancer Institute

  27. Ahmed M, et al. (2014) Image-guided tumor ablation: standardization of terminology and reporting criteria—a 10-year update. Radiology 273(1):241–260

    Article  PubMed  PubMed Central  Google Scholar 

  28. Ioannou GN, Perkins JD, Carithers RL Jr (2008) Liver transplantation for hepatocellular carcinoma: impact of the MELD allocation system and predictors of survival. Gastroenterology 134(5):1342–1351

    Article  PubMed  Google Scholar 

  29. Herden U, et al. (2010) Sorafenib-induced severe acute hepatitis in a stable liver transplant recipient. Transplantation 90(1):98–99

    Article  PubMed  Google Scholar 

  30. Lu DS, et al. (2005) Percutaneous radiofrequency ablation of hepatocellular carcinoma as a bridge to liver transplantation. Hepatology 41(5):1130–1137

    Article  PubMed  Google Scholar 

  31. Mazzaferro V, et al. (2004) Radiofrequency ablation of small hepatocellular carcinoma in cirrhotic patients awaiting liver transplantation: a prospective study. Ann Surg 240(5):900–909

    Article  PubMed  PubMed Central  Google Scholar 

  32. Livraghi T, et al. (2008) Sustained complete response and complications rates after radiofrequency ablation of very early hepatocellular carcinoma in cirrhosis: is resection still the treatment of choice? Hepatology 47(1):82–89

    Article  PubMed  Google Scholar 

  33. Liang P, et al. (2009) Malignant liver tumors: treatment with percutaneous microwave ablation–complications among cohort of 1136 patients. Radiology 251(3):933–940

    Article  PubMed  Google Scholar 

  34. Liang P, et al. (2012) Percutaneous cooled-tip microwave ablation under ultrasound guidance for primary liver cancer: a multicentre analysis of 1363 treatment-naive lesions in 1007 patients in China. Gut 61(7):1100–1101

    Article  PubMed  Google Scholar 

  35. Martin RC, Scoggins CR, McMasters KM (2010) Safety and efficacy of microwave ablation of hepatic tumors: a prospective review of a 5-year experience. Ann Surg Oncol 17(1):171–178

    Article  PubMed  Google Scholar 

  36. Poulou LS, et al. (2015) Percutaneous microwave ablation vs radiofrequency ablation in the treatment of hepatocellular carcinoma. World J Hepatol 7(8):1054–1063

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Radiology, Mayo Clinic, 200 1st ST SW, Rochester, MN, 55905, USA

    Brian T. Welch, J. J. Schmitz, A. N. Kurup, T. D. Atwell, M. R. Callstrom & G. D. Schmit

  2. Department of Radiology, Mayo Clinic, Jacksonville, FL, USA

    Brian T. Welch, G. Frey & R. Paz-Fumagalli

  3. Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA

    Brian T. Welch, A. Allen & K. Watt

  4. Department of Transplantation Surgery, Mayo Clinic, Rochester, MN, USA

    Brian T. Welch & J. Heimbach

Authors
  1. Brian T. Welch
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  2. J. J. Schmitz
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  3. A. N. Kurup
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  4. T. D. Atwell
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  5. M. R. Callstrom
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  6. G. Frey
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  7. R. Paz-Fumagalli
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  8. A. Allen
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  9. K. Watt
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  10. J. Heimbach
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  11. G. D. Schmit
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Corresponding author

Correspondence to Brian T. Welch.

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Funding

No sources of funding were utilized.

Conflict of interest

All authors declare no conflicts of interest.

Ethical approval

This study was performed after approval by the institutional review board. Informed consent is obtained prior to each percutaneous ablation procedure.

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Welch, B.T., Schmitz, J.J., Kurup, A.N. et al. Feasibility and outcomes of percutaneous thermal ablation of hepatocellular carcinoma in a transplanted allograft. Abdom Radiol 43, 1478–1481 (2018). https://doi.org/10.1007/s00261-017-1323-0

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  • DOI: https://doi.org/10.1007/s00261-017-1323-0

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