Hepatocellular carcinoma (HCC) with portal vein tumoral thrombosis (PVTT) represents a major concern especially in the field of deceased donor liver transplantation (DDLT). However, when receiving transarterial radioembolization (TARE), a considerable percentage of such patients are able to achieve a radiologic complete response with adequate survival rates. In this pilot prospective study, we evaluated the effect of TARE in downstaging HCC patients with PVTT to meet criteria for DDLT. Between May 2013 and November 2016, patients were evaluated to be enrolled into our “Superdownstaging” protocol. Patients received yttrium-90 TARE and were enlisted for DDLT in case of complete and sustained (6 months) radiological response. Patients with tumor thrombus in the main trunk and/or in the contralateral portal vein branch were excluded. TARE was effective in downstaging and receiving DDLT in 5/17 patients (29.4%). The 5-year overall survival was significantly higher in patients who underwent DDLT compared with those who were not transplanted (60.0% versus 0.0%, P = 0.03). Three out of 5 patients developed recurrence within 1 year after LT. The current series showed a clear survival gain in those patients who were able to receive DDLT after TARE but careful selection for DDLT is however advised.

中文翻译：

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肝细胞癌和门静脉肿瘤血栓形成放射栓塞后的已故供体肝移植：一项初步研究

伴有门静脉肿瘤血栓形成 (PVTT) 的肝细胞癌 (HCC) 是一个主要问题，尤其是在已故供体肝移植 (DDLT) 领域。然而，当接受经动脉放射栓塞术 (TARE) 时，相当大比例的此类患者能够实现放射学完全缓解并具有足够的生存率。在这项前瞻性前瞻性研究中，我们评估了 TARE 在使用 PVTT 对 HCC 患者进行降期以满足 DDLT 标准方面的效果。2013 年 5 月至 2016 年 11 月期间，对患者进行了评估，以纳入我们的“超级降期”方案。患者接受 yttrium-90 TARE 治疗，并在出现完全和持续（6 个月）放射学反应的情况下接受 DDLT。排除主干和/或对侧门静脉分支的肿瘤血栓患者。TARE 对 5/17 患者 (29.4%) 的降期和接受 DDLT 有效。与未接受移植的患者相比，接受 DDLT 的患者的 5 年总生存率显着更高（60.0% 对 0.0%，P  = 0.03）。5 名患者中有 3 名在 LT 后 1 年内出现复发。目前的系列研究表明，那些在 TARE 后能够接受 DDLT 的患者的生存率明显提高，但建议谨慎选择 DDLT。