116 - Shift in Transarterial Modality of Choice for Hepatocellular Carcinoma and Its Association with Achieving Complete Pathologic Necrosis

Monday, April 13, 2026

4:03 PM - 4:12 PM ET

Presenting Author(s)

Breanna Collins, BS (she/her/hers)

Medical Student
University of California, San Diego School of Medicine, United States

Author/Co-author(s)

SW

Stephanie Wu

Student Researcher
UCSD Undergraduate, United States
Vasan Jagadeesh

Medical Student
University of California, San Diego School of Medicine, United States
CK

Cody A. Keller, MD

Resident Physician
University of California, San Diego, United States
JM

Jeet Minocha, MD (he/him/his)

Professor, Division of Interventional Radiology
University of California San Diego, United States
GS

Gabriel Schnickel, MD

Faculty hepatobiliary and transplant surgery physician
University of California San Diego, United States
AB

Adam Burgoyne, MD, PhD

Associate Clinical Professor
University of California, San Diego, United States
ZB

Zachary Berman, MD

Associate Professor of Clinical Radiology
University of California, San Diego, United States

Purpose: Liver transplantation is the gold standard treatment for hepatocellular carcinoma (HCC). Bridging locoregional therapy (LRT) before transplantation improves survival post-transplant, which is best seen in those achieving complete pathologic necrosis (CPN). Historically, transarterial chemoembolization (TACE) was the dominant bridging modality. However, over the past decade transarterial radioembolization (TARE) has become the most utilized therapy, likely due to refinements in dosimetric approaches. This study hypothesizes that TARE’s likelihood to achieve CPN has improved over time, and this improvement parallels increased adoption of TARE versus TACE as the main transarterial bridging therapy. A secondary aim was evaluate progression-free survival (PFS) by CPN in this cohort.

Materials and Methods: A retrospective analysis of consecutive lesions from patients who underwent transplant from 2010-2024 at a single institution. CPN was defined as 100% tumor necrosis on the explant specimen. Temporal trends in CPN proportions and amount of lesions that were treated with TARE versus TACE were assessed using the Cochran-Armitage test. PFS by CPN was evaluated with Kaplan-Meier curves.

Results: A total of 266 lesions from 149 patients (68% male) were included with a mean age at transplant of 61.6 years. The etiology of chronic liver disease included HCV (40%), multifactorial (28%), alcohol (13%), MASLD (12%), HBV (5%), and other (2%). Among lesions treated with TARE, the proportion achieving CPN increased significantly over time from 35% before 2019 to 84% after 2019 (p < 0.001). Among lesions treated with TACE, there was no significant difference in the proportion achieving CPN over time from 33% before 2019 to 29% after 2019 (p = 0.79). The relative utilization of TARE compared with TACE significantly increased over time from 9% of lesions treated in 2011 to 86% in 2024 (p < 0.0001 ). Although median PFS was not reached in either the CPN or incomplete necrosis group, the Kaplan-Meier curves did significantly diverge with patients with CPN having a decreased risk of progression (p = 0.03).

Conclusion: Complete pathologic necrosis has been shown to improve post-transplant outcomes; this study validated that patients with CPN had improved PFS. This study found that, over the past 14 years, TARE’s rate of achieving CPN has improved significantly – likely due to improved dosimetry techniques - and its increased utilization outpaced TACE.