Liver Transplantation for Hepatocellular Carcinoma: Prognostic Impact of Complete Pathologic Response and Influence of Treatment Modality—A US National Database Study

Highlights

• Complete pathologic response (cPR) occurs in approximately one-third of HCC patients undergoing liver transplantation and is strongly associated with improved overall and recurrence-free survival.
• Yttrium-90 (Y-90) radioembolization and ablation therapies independently increase cPR rates compared to transarterial chemoembolization (TACE), with Y-90 showing the greatest efficacy especially when administered early within six months of waitlisting.
• Imaging-based assessments frequently overestimate treatment response, highlighting the importance of pathological evaluation for accurate prognosis.
• Predictors of cPR include lower tumor burden, normal or moderately elevated alpha-fetoprotein (AFP) levels, longer waitlist times, and specific locoregional treatment choice.