Successful TACE followed by OLT for HCC in Alcoholic Cirrhosis

History of Present Illness 63 y/o male 3 year history of end stage liver disease secondary to alcohol (since abstinent) Referred for management of HCC 8.5 cm liver lesion AFP of 12,526 (June 2006)

Past Medical History Cirrhosis – EtOH HCC Diabetes Mellitus type 2 Encephalopathy Grade 2 varices No ascites HCC Diabetes Mellitus type 2 Ischemic cardiomyopathy – EF 40% Asthma Vitiligo

Investigations Hg 12.5, Plt 32, INR 1.54 AST 45, ALT 50, Alk P 53 TB 1.3, Alb 2.6, Cr 0.9 MELD 12

Treatment – June 2006 Chemoembolization with cisplatin Long acting octreotide Bevacizumab

Follow-up September 2006 - AFP 3.5 Negative PET scan CT-abdomen …

June 2006 September 2006

Liver Transplant Evaluation Cardiac evaluation cleared for liver transplant Worsening MELD, listed for OLT Transplanted February 1, 2007 Explant: 3cm necrotic area, no tumor 4 year post OLD no recurrence