Successful Tace in Patient with large HCC

History 65 y/o hispanic (Cuban) male with alcoholic + NASH-related cirrhosis diagnosed in October 03 (since abstinent) Referred for HCC (8.5 cm) management 10/06 PMH DM Asthma Cholecystectomy Obesity Alcoholic cardiomyopathy (compensated)

Cirrhosis Hepatic encephalopathy related hospitalization H/O grade 1–2 varices, no GI bleed No ascites/edema/jaundice Biological MELD – 12 (2006) Diagnosed with 8.5 cm HCC in 2006 on US, CT and MRI during screening AFP in June 2006 was 12,526

Medications Digoxin Rifaximin Fluoxetine Montelukast Bumetanide Spironolactone

TACE with ethiodol cisplatin combination and embolisation with gelfoam

Post TACE CT scan

Therapy (cont’d) Adjuvant therapy Tumor size 8.5 3 cm in 4 months Bevacizumab Octreotide Tumor size 8.5 3 cm in 4 months AFP 12,526  3.1(10/06)

Post TACE labs Sodium 140 Hemoglobin 12.4 Potassium 3.6 HCT 37.2 BUN/Cr 14/0.9 INR 1.54 Total Bilirubin 1.3 AST 45 ALT 50 Alk. Phosphatase 124 Albumin 2.6 Biological MELD score 12 Hemoglobin 12.4 HCT 37.2 WBC 3.3 Platelets 32K

Liver Transplant OLT on 2/1/07 with a MELD of 17 [biological] Explant pathology Cirrhosis with mild inflammatory activity Area of 3 cm necrosis No residual viable carcinoma No vascular invasion

Post Liver Transplantation Patient doing well No complications No tumor recurrence

Follow-up triple phase CT at 2 years