Successful TACE for HCC

History A 50 y/o white male with a history of HCV cirrhosis, who was referred for an evaluation for liver transplantation Risk factors for HCV included: 1) Ex-IVDU in the 1960’s 2) Multiple blood transfusions in 1975

History His end-stage liver disease was complicated by: 1) Esophageal variceal bleed 2) Portosystemic encephalopathy 3) Ascites 4) Hepatic lesion measuring 6 x 6.5 x 7cm in segment 7 with an elevated serum AFP > 16,000 ng/ml

Physical Examination HEENT: Sclera anicteric ABD: Hepatomegaly of 16 cm, splenomegaly No shifting dullness EXT: 1+ pitting edema of lower extremities. No asterixis Neuro: AO x3

Laboratory Data WBC 3.6/ul Albumin 2.5 g/dl Hb 9.5 g/dl AST 148 U/L Platelets 50/ul ALT 118 U/L Creatinine 1.0 g/dl INR 1.22 MELD 13 Total bili 3.4 mg/dl AFP 13,874 ng/ml

Figure – 1 (CT scan of 1/29/02)

Subsequently in February 2002, He underwent chemoembolization with mitomycin, adriamycin and carboplatinum

Figure –2 (CT scan of 4/10/02)

Serial serum AFP levels decreased to:. - 164 ng/ml in 5/02 Serial serum AFP levels decreased to: - 164 ng/ml in 5/02 - 113 ng/ml in 7/02

On August 25, 2002 the patient underwent cadaveric liver transplantation

Figure – 3 (Explant 8/25/02).

After 7 months of follow-up The patient is doing well There is no evidence of recurrence on serial abdominal imaging and serum AFP levels Since there was no evidence of hepatocellular carcinoma on explant, the decision was made not to treat patient with chemotherapy