Background : Individuals with hepatocellular carcinoma (HCC) not meeting the Milan criteria are usually not considered for liver transplantation (LT) unless at facilities with their own set criteria. This study examines HCC patients outside these criteria, assessing how downstaging and bridging (D&B) techniques reduce tumor burden for LT eligibility and analyzing post-transplant outcomes.

Methods : Out of 74 HCC patients underwent LT, we excluded 26 patients who received LT without prior D&B. The remaining 48 patients, consisted of 35 males and 13 females with an average age of 59.04 and a mean MELD score of 14.35. Their demographic data, surgical details, prognoses, and pathology findings were analyzed.

Results : Locoregional treatments were administered to 37 patients (77.1%) for bridging and 11 patients (22.9%) for downstaging. The average tumor size before bridging was 3.22 cm, and 6.65 cm for downstaging, with a mean AFP level of 233.46. Significantly, post-D&B treatment, the average tumor size decreased from 3.40 cm to 2.47 cm, which was smaller than observed in explant pathology (p<0.05). The type of locoregional treatment did not significantly affect tumor impact or prognosis. Recurrent patients had a shorter time between diagnosis and D&B but a longer interval between D&B and LT (p<0.05). Non-recurrent patients had significantly smaller tumors in pathology than those with recurrence.

Conclusions : We noted an increase in the number of patients eligible for LT after D&B. This suggests that applying locoregional therapies more frequently and effectively in HCC patients outside the Milan criteria could improve their LT prospects and potentially extend their survival.