Systematic review and meta-analysis of posttransplant hepatic artery and biliary complications in patients treated with transarterial chemoembolization before liver transplantation.

Background: Hepatic artery complications are feared complications after liver transplantation and may compromise the biliary tract, graft and patient survival. The objective of this systematic review and meta-analysis was to compare risk of hepatic artery and biliary complications after liver transplantation in patients who underwent neoadjuvant transarterial chemoembolization (TACE) vs. no TACE. Methods: Comprehensive searches were performed in Embase, MEDLINE OvidSP, Web of Science, Google Scholar and Cochrane databases to identify studies concerning hepatocellular cancer patients undergoing preliver transplantation TACE. Quality assessment of studies was done by the validated checklist of Downs and Black. Meta-analyses were performed to evaluate the incidence of all hepatic artery complications, hepatic artery thrombosis and biliary tract complications, using binary random-effect models. Prospero registration: CRD42016025734. Results: Fourteen retrospective studies, representing 1122 TACE patients, met the inclusion criteria. Postoperative hepatic artery complications consisted of hepatic artery thrombosis, stenosis and (pseudo)-aneurysms. Preliver transplantation TACE was significantly associated with occurrence of posttransplant hepatic artery complications (OR: 1.57, 95%CI 1.09-2.26, p 0.02). No significant association between neoadjuvant TACE and hepatic artery thrombosis alone or biliary tract complications was found. Conclusions: Patients treated with transarterial chemoembolization before liver transplantation may be at increased risk for development of hepatic artery complications after liver transplantation. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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