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Prajapati et al. TACE in recurrent HCC after OLT

We acknowledge, this study has several limitations. grading determine outcome after liver transplantation for
First, the sample size of the study is small and so results hepatocellular carcinoma in cirrhosis. Hepatology 2001;33:1080-6.
should be taken as preliminary data. Second, this is a 4. Ferris JV, Baron RL, Marsh JW Jr, Oliver JH 3rd, Carr BI, Dodd GD
single institution non-randomized study, so selection 3rd. Recurrent hepatocellular carcinoma after liver transplantation:
spectrum of CT findings and recurrence patterns. Radiology
bias and late look bias may be inherent. Third, patients 1996;198:233-8.
who were treated with sorafenib (25%) were also 5. Peck-Radosavljevic M, Pidlich J, Bergmann M, Ferenci P, Seelos
included in this study, so outcomes after DEB TACE C, Wichlas M, Lipinski E, Gnant M, Gangl A, Muhlbacher F.
may be confounded. However, concomitant therapy Preoperative TNM-classification is a better prognostic indicator for
with sorafenib did not significantly affect survival in recurrence of hepatocellular carcinoma after liver transplantation
univariate analysis. Therefore, we believe that survival than albumin mRNA in peripheral blood. Liver Transplant Oncology
advantage in this study is largely from the effect of 6. Group. J Hepatol 1998;28:497-503.
Dudek K, Kornasiewicz O, Remiszewski P, Kobryn K, Ziarkiewicz-
DEB TACE therapy. Wroblewska B, Gornicka B, Zieniewicz K, Krawczyk M. Impact of
tumor characteristic on the outcome of liver transplantation in patients
In conclusion, recurrence of HCC after OLT is not with hepatocellular carcinoma. Transplant Proc 2009;41:3135-7.
uncommon. DEB TACE could help to extend the 7. Zhou B, Shan H, Zhu KS, Jiang ZB, Guan SH, Meng XC, Zeng
survival of the patients with recurrent HCC after XC. Chemoembolization with lobaplatin mixed with iodized oil for
OLT. As the sample size of the study is small, the unresectable recurrent hepatocellular carcinoma after orthotopic liver
results should be taken as preliminary. Further, multi- 8. transplantation. J Vasc Interv Radiol 2010;21:333-8.
Yamagami T, Yoshimatsu R, Ishikawa M, Kajiwara K, Aikata H,
institutional prospective trial is needed to explore its Tashiro H, Kakizawa H, Toyoda N, Ohdan H, Awai K. Transcatheter
benefit on these patients with recurrence of HCC after arterial chemoembolization with an interventional-CT system
OLT. Patients with poorly differentiated HCC of explant for recurrent hepatocellular carcinoma after living donor liver
liver, > 400 ng/dL AFP and metastases at the time of transplantation. Hepatogastroenterology 2014;61:1387-92.
TACE had a poor overall prognosis. 9. Bruix J, Sherman M. Management of hepatocellular carcinoma.
Hepatology 2005;42:1208-36.
10. Prajapati HJ, Dhanasekaran R, El-Rayes BF, Kauh JS, Maithel SK,
DECLARATIONS Chen Z, Kim HS. Safety and efficacy of doxorubicin drug-eluting
bead transarterial chemoembolization in patients with advanced
Authors’ contributions hepatocellular carcinoma. J Vasc Interv Radiol 2013;24:307-15.
All three authors were involved with study concept, 11. Roayaie S, Schwartz JD, Sung MW, Emre SH, Miller CM, Gondolesi
GE, Krieger NR, Schwartz ME. Recurrence of hepatocellular
design, acquisition of data, analysis and interpretation carcinoma after liver transplant: patterns and prognosis. Liver Transpl
of data, drafting of the manuscript and critical revision 2004;10:534-40.
of the manuscript for important intellectual content. 12. Kornberg A, Kupper B, Tannapfel A, Katenkamp K, Thrum
K, Habrecht O, Wilberg J. Long-term survival after recurrent
Financial support and sponsorship hepatocellular carcinoma in liver transplant patients: clinical patterns
and outcome variables. Eur J Surg Oncol 2010;36:275-80.
None. 13. Orlando A, Leandro G, Olivo M, Andriulli A, Cottone M.
Radiofrequency thermal ablation vs. percutaneous ethanol injection
Conflicts of interest for small hepatocellular carcinoma in cirrhosis: meta-analysis of
There are no conflicts of interest. randomized controlled trials. Am J Gastroenterol 2009;104:514-24.
14. Shiina S. Image-guided percutaneous ablation therapies for
hepatocellular carcinoma. J Gastroenterol 2009;44 Suppl 19:122-31.
Patient consent 15. Cheng AL, Kang YK, Chen Z, Tsao CJ, Qin S, Kim JS, Luo R, Feng J,
Obtained. Ye S, Yang TS, Xu J, Sun Y, Liang H, Liu J, Wang J, Tak WY, Pan H,
Burock K, Zou J, Voliotis D, Guan Z. Efficacy and safety of sorafenib
Ethics approval in patients in the Asia-Pacific region with advanced hepatocellular
carcinoma: a phase III randomised, double-blind, placebo-controlled
The study is approved by the Local Institutional trial. Lancet Oncol 2009;10:25-34.
Review Board and is Health Insurance Portability and 16. Llovet JM, Ricci S, Mazzaferro V, Hilgard P, Gane E, Blanc JF, de
Accountability Act compliant. Oliveira AC, Santoro A, Raoul JL, Forner A, Schwartz M, Porta
C, Zeuzem S, Bolondi L, Greten TF, Galle PR, Seitz JF, Borbath I,
Haussinger D, Giannaris T, Shan M, Moscovici M, Voliotis D, Bruix
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