Biliary Complications in Patients Undergoing Liver Transplantation after Previous TACE Treatment

Abstract

Background and Aims: Transarterial chemoembolization (TACE) are widely used as bridging or downstaging therapy in patients with hepatocellular carcinoma (HCC awaiting liver transplantation (LT). However, concerns persist regarding potential ischemic or cytotoxic effects of TACE on the biliary system and their impact on post-transplant biliary complications. Methods: We retrospectively analysed 109 patients who underwent liver transplantation for curative treatment of HCC between 2008 and 2020 at a single tertiary centre. Eighty patients received pre-transplant TACE, while 29 served as controls. Biliary complications were defined by cholestatic laboratory abnormalities combined with confirmatory imaging findings and classified as anastomotic strictures, non-anastomotic strictures (ischemic-type biliary lesions), or biliary leakage. Group comparisons were performed using non-parametric and categorical tests. Multivariable logistic regression was conducted to identify independent risk factors for biliary complications, including number of TACE procedures, ischemia times, and cardiovascular comorbidities. Results: Overall, biliary complications occurred in 29/109 patients (26.6%). Incidences did not differ significantly between the TACE and control groups (22.5% vs. 37.9%, p = 0.141). Rates of anastomotic strictures, non-anastomotic strictures, and biliary leakages were comparable between groups and showed no significant differences. Combined arterial and biliary complications were rare (3.6%) and occurred exclusively in patients without prior TACE. In multivariable analysis, neither the number of TACE procedures nor ischemia times or cardiovascular comorbidities emerged as independent predictors of biliary complications. Conclusion: Pre-transplant TACE was not associated with an increased risk of biliary complications following liver transplantation. These findings support the safety of TACE as a bridging or downstaging strategy in transplant candidates with HCC. Lay Summary: This study evaluated whether transarterial chemoembolization (TACE) before liver transplantation in patients with hepatocellular carcinoma is associated with an increased risk of postoperative biliary complications. The results showed no significant difference in biliary complication rates between patients who received TACE and those who did not, indicating that pre-transplant TACE appears to be treatment option for bridging and downstaging prior to transplantation.