1. Successful TACE followed by OLT for HCC in Alcoholic Cirrhosis

2. 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)

4. 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

5. 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

6. Treatment – June 2006 Chemoembolization with cisplatin
Long acting octreotide
Bevacizumab

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

9. June September 2006

10. 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