73 - Evaluating Long-Term Outcomes of Liver Transplantation After Y-90 Radioembolization for Hepatocellular Carcinoma

Sunday, April 12, 2026

3:18 PM - 3:27 PM ET

Presenting Author(s)

PJ

Pittra Jaengprajak, BS

Medical Student
University of Washington School of Medicine, United States

Author/Co-author(s)

AB

Aarohi Bhatt, MD

Postdoctoral Research Fellow
University of Washington, United States
SS

Sarabjeet Singh, MD, MBA, MBBS

Director of CT Research
University of Washington, United States
DS

Dushyant Sahani, MD

Professor and Chair
University of Washington, United States
Grace Laidlaw, MD, MS (she/her/hers)

Assistant Professor
University of Washington, United States

Purpose: To evaluate long-term overall survival (OS) and pathologic response in patients with hepatocellular carcinoma (HCC) who underwent liver transplantation (LT) following Yttrium-90 transarterial radioembolization (TARE), and to compare outcomes with LT recipients without prior Y-90.

Materials and Methods: Single-institution retrospective study of 214 patients with HCC who underwent LT between January 2015 and January 2025. Among these, 97 patients received Y-90 TARE prior to LT with glass or resin microspheres. Demographic, clinical, treatment, and histopathologic data were collected from institutional records. OS was estimated with Kaplan–Meier methods, and survival differences between Y-90 and non–Y-90 patients were assessed using log-rank and Wilcoxon (Breslow) tests.

Results: Among 97 patients who underwent Y-90 prior to LT, median age was 63 years; 80% were male and 20% female. The median baseline MELD score at LT was 11. Liver disease etiologies included HCV (38%), alcoholic cirrhosis (24%), NASH (16%), HBV (11%), other causes (8%), and autoimmune disease (2%). Of 94 patients with available treatment data, glass microspheres were used in 97% and resin microspheres in 3%. The median interval from the first Y-90 to LT was 265 days.

Pre-LT imaging categorized treated lesions as LR-5 in 73%, LR-4 in 11%, and other in 15%. On explant pathology, complete necrosis was observed in 26% of treated lesions and extensive necrosis (75–99%) in 22%. Microvascular invasion was present in 5%, and viable tumor in 62%.

For the Y-90 cohort, OS at 3, 5, and 10 years was 88.6%, 88.6%, and 30.5%, respectively. HCC recurrence occurred in 7% of patients after LT. Compared with LT recipients without prior Y-90 (n=117), OS was significantly different (log-rank p=0.021; Wilcoxon p=0.045), with non–Y-90 patients achieving 95.7%, 92.8%, and 85.0% survival at 3, 5, and 10 years. In the overall LT cohort (n=214), OS at 3, 5, and 10 years was 92.6%, 90.7%, and 80.5%.

Conclusion: LT after Y-90 achieved significant pathologic response (≈48% of explants showing ≥75% necrosis) and favorable 3- and 5-year overall survival in patients who often presented with advanced LR-5/LR-4 lesions. Although 10-year survival was statistically higher in LT recipients without prior Y-90, this likely reflects less aggressive tumor biology at the time of transplantation in that group. These findings support Y-90 as an effective bridging or downstaging strategy for disease control in selected HCC candidates.