1. Successful Tace in Patient with large HCC

2. History
65 y/o hispanic (Cuban) male with alcoholic + NASH-related cirrhosis diagnosed in October 03 (since abstinent)
Referred for HCC (8.5 cm) management 10/06
PMH DM
Asthma
Cholecystectomy
Obesity
Alcoholic cardiomyopathy (compensated)

3. Cirrhosis Hepatic encephalopathy related hospitalization
H/O grade 1–2 varices, no GI bleed
No ascites/edema/jaundice
Biological MELD – 12 (2006)
Diagnosed with 8.5 cm HCC in 2006 on US, CT and MRI during screening
AFP in June 2006 was 12,526

4. Medications Digoxin Rifaximin Fluoxetine Montelukast Bumetanide
Spironolactone

6. TACE with ethiodol cisplatin combination and embolisation with gelfoam

7. Post TACE CT scan

8. Therapy (cont’d) Adjuvant therapy Tumor size 8.5 3 cm in 4 months
Bevacizumab
Octreotide
Tumor size 8.5 3 cm in 4 months
AFP 12,526  3.1(10/06)

9. Post TACE labs Sodium 140 Hemoglobin 12.4 Potassium 3.6 HCT 37.2
BUN/Cr 14/0.9
INR 1.54
Total Bilirubin 1.3
AST 45
ALT 50
Alk. Phosphatase 124
Albumin 2.6
Biological MELD score 12
Hemoglobin 12.4
HCT 37.2
WBC 3.3
Platelets 32K

10. Liver Transplant OLT on 2/1/07 with a MELD of 17 [biological]
Explant pathology
Cirrhosis with mild inflammatory activity
Area of 3 cm necrosis
No residual viable carcinoma
No vascular invasion

11. Post Liver Transplantation
Patient doing well
No complications
No tumor recurrence

12. Follow-up triple phase CT at 2 years