Efficacy of transarterial radioembolization versus transarterial chemoembolization as bridging therapy to liver transplantation for patients with hepatocellular carcinoma

Introduction: There is scant data in the literature about the optimal bridging locoregional treatment (LRT) option for hepatocellular carcinoma (HCC) in patients on the liver transplant (LT) waitlist. LRT resulting in complete pathologic necrosis of HCC on liver explant has been shown to improve HCC recurrence free survival in LT recipients.
The main objective of this study is to evaluate the effectiveness of trans-arterial radioembolization (TARE) based LRT protocol versus trans-arterial chemoembolization (TACE) based LRT protocol in achieving complete pathologic necrosis of hepatocellular carcinoma on liver explant specimens of patients, who underwent LT.
Methods: This is a single-center retrospective study of 80 consecutive HCC patients, who underwent LT between January 1, 2010, and August 31, 2025. Patients with HCC were primarily treated with TACE based LRT protocol between January 1, 2010, till December 31, 2019. Subsequently, patients with HCC were primarily treated with TARE based LRT protocol between January 1, 2020 till August 31, 2025.  Patients were excluded if there was any crossover between TACE and TARE treatment arms. We compared pathologic necrosis, microvascular invasion, recurrence rate, and overall survival between two study groups.
Results: Out of 80 HCC LT recipients, 64 patients (with total of 97 HCC lesions) underwent TACE based LRT and 16 patients (with total of 23 HCC lesions) underwent TARE based LRT. There was a longer interval between last TARE based LRT to LT compared to last TACE based LRT to LT (456 days vs 238 days, p 0.003) suggestive of more durable radiologic treatment response with TARE on LT waitlist. Mean number of LRT sessions were similar between TACE based LRT and TARE based LRT (1.28 vs 1.39, p 0.387). Complete pathologic necrosis was identified in 19/23 (83%) TARE treated HCC lesions compared to 51/97 (53%) TACE treated HCC lesions (p 0.01). Microvascular invasion was identified in 1/16 (6%) of TARE treated HCC patients compared to 8/97 (8%) of TACE treated HCC patients (p 0.479). There was no statistically significant difference in 2-year HCC recurrence rates between two groups (0% in TARE group vs 11% in TACE group, p 0.334). There was no statistically significant difference in overall 2-year survival rates between 2 groups (88% in TARE group vs 92% in TACE group, p 0.281).

Conclusion: TARE based LRT achieved higher proportion of complete pathologic necrosis of HCC lesions compared to TACE based LRT on liver explant.