DEB-TACE Prior to Liver Transplantation in the Treatment of HCC

Prior treatment

• Concurrent active hepatitis or severe infection;

Other illness

• Presence of definite cancer thrombi in the main portal vein, vena cava, or main bile duct;
• Coexisting pulmonary arterial hypertension (moderate to high risk, WHO Grade III-IV);
• Severe contrast agent allergy;
• Inability to tolerate surgical anesthesia (severe infection, cardiopulmonary insufficiency, cerebrovascular disease);
• Severe psychiatric illness;

Lab values

• Renal dysfunction, creatinine \>176.8 umol/L or creatinine clearance rate \<30ml/min;
• White blood cell count \<3.0x109/L, platelet count \<50x106/L, and unable to correct;

Other

• Severe hepatic encephalopathy;
• Irreversible hepatic artery to hepatic vein shunt;
• Special types of anatomical variations (Asan portal vein type III);
• Extrahepatic metastatic tumors;
• Tumor dissemination or distant metastasis, expected survival \<3 months;
• Other reasons deemed unsuitable for participation by the investigator.

• Age 18-75 years;
• Subjects with viral hepatitis or cirrhosis are clinically diagnosed according to AASLD standards, which require a history of viral hepatitis or cirrhosis combined with imaging examinations (enhanced CT, MRI, second-generation ultrasound contrast agents). When the tumor diameter is greater than 2 cm, a diagnosis can be made if one imaging technique shows typical arterial phase rapid enhancement and rapid washout. If the diameter is 1-2 cm, two imaging techniques must confirm this, or one imaging technique confirms it and alpha-fetoprotein (AFP) is greater than 400 ng/ml. For subjects who cannot be clinically diagnosed, histological or cytological biopsy confirmation is required; original biopsy records can also be used for diagnosis.
• Child-Pugh score A-B grade;
• Tumor present in the right lobe of the liver;
• Liver cancer assessment meeting the "up to seven" criteria: the sum of tumor size and number does not exceed 7;
• ECOG-PS score 0-1;
• Scheduled for living donor liver transplantation as the primary treatment;
• Signed informed consent form.