Pilot study of high-intensity focused ultrasound ablation as a bridging therapy for hepatocellular carcinoma patients wait-listed for liver transplantation

Objective: To investigate the outcomes of high-intensity focused ultrasound (HIFU) ablation as a bridging therapy for patients with hepatocellular carcinoma (HCC) waitlisted for deceased-donor liver transplantation. Patients and Methods: Adult patients with unresectable and unablatable HCCs within the UCSF criteria waitlisted for deceased-donor liver transplantation were screened for suitability for HIFU ablation as a bridging therapy if they were not suitable for transarterial chemoembolization (TACE). Comparison of treatment outcomes was made between patients receiving HIFU ablation, TACE and best medical treatment (BMT). Results: Fifty-one patients were included in the analysis. Before the introduction of HIFU ablation, only 39.2% of patients received bridging therapy (TACE only, n=20). With HIFU ablation in use, the rate increased dramatically to 80.4% (TACE+HIFU, n=20+21). The overall dropout rate was 51% (n=26). Patients in the BMT group had a significantly higher dropout rate (p=0.027) and significantly poorer liver function as reflected by higher Model of End-stage Liver Disease scores and Child-Pugh grading. Clinically relevant ascites was found in 5 patients in the HIFU group and 2 patients in the BMT group but none in the TACE group (p=0.010 and 0.029). The TACE and HIFU groups had comparable percentages of tumor necrosis in livers excised (p=0.353), both significantly higher than that in the BMT group (p=0.010 and 0.020). Conclusions: HIFU ablation was safe even for HCC patients with Child-Pugh C disease. Its adoption increased the percentage of patients receiving bridging therapy from 39.2% to 80.4%