Elsevier

Transplantation Proceedings

Volume 43, Issue 6, July–August 2011, Pages 2213-2215
Transplantation Proceedings

Liver
Candidate
Value of 18-FDG-Positron Emission Tomography/Computed Tomography Before and After Transarterial Chemoembolization in Patients With Hepatocellular Carcinoma Undergoing Liver Transplantation: Initial Results

https://doi.org/10.1016/j.transproceed.2011.05.023Get rights and content

Abstract

Introduction

Liver transplantation is the treatment of choice for various types of end-stage liver disease and the most appropriate alternative for the treatment of hepatocellular carcinoma (HCC)-associated liver cirrhosis. The aim of this study was to describe our initial experience with the use of 18-FDG positron emission tomography (PET)/computed tomography CT before and after transarterial chemoembolization (TACE) in HCC patients undergoing liver transplantation, seeking to predict the percentage of tumor necrosis achieved by TACE procedures.

Patients and Methods

From January 2007 through December 2009, 39 patients with HCC and liver cirrhosis were included in our liver transplantation program. We selected the 6 subjects who underwent 18-fluorodeoxyglucose PET/CT (18-FDG PET/CT) pre- and post-TACE.

Results

The median SUV (standarized uptake value) in the lesions studied were 4 (range, 2.79–6.95) before TACE with a median post-TACE SUV of 0 (range, 0–4). Among patients whose post-TACE SUV decreased to <3, the percentage of necrosis after studying the hepatectomy was >80%.

Conclusion

Performance of an 18-FDG PET/CT before and after TACE and comparison of SUV in patients with HCC awaiting liver transplantation provided valuable information regarding the effectiveness of TACE.

Section snippets

Patients and Methods

From January 2007 through December 2009, 39 patients with HCC and liver cirrhosis were included in our liver transplantation program. All patients who were enrolled for OLT met the Milan criteria, namely, a single tumor ≤5 cm or no more than 3 nodules with the greatest not exceeding 3 cm. Before OLT TACE was used to treat HCC in 21 candidates. TACE procedures were performed with tumor embolization using drug-eluting beads containing adriamycin after arteriography identified the major arterial

Results

Six patients who underwent an 18-FDG PET/CT before and after TACE included 3 with hepatitis C virus (HCV)-related cirrhosis, one of them with HCV and alcohol 2 with alcoholic cirrhosis, 1 with hepatitis B virus (HBV)-related cirrhosis. The median patient age was 64 years (range, 34–72), with a median time on the waiting list for OLT of 113 days (range, 60–123). All patients underwent a single TACE procedure with drug-eluting beads (adiramycin). The PET data reporting percentage of tumor

Discussion

HCC is now the leading cause of death among patients with liver cirrhosis. The diagnosis should be established in the early stages of the disease, while curative therapies are still possible. Programs for early detection of HCC among cirrhotic patients include alpha-fetoprotein (AFP) levels and regular monitoring of ultrasounds. Currently the best therapeutic option for cirrhotic patients is OLT. However, the increase in patients on the waiting list has led to strategies to minimize the impact

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