Bridging and downstaging treatments for hepatocellular carcinoma in patients on the waiting list for liver transplantation

Table 1 Advantages and disadvantages of the bridging and downstaging procedures for hepatocellular carcinoma in cirrhotic patients who are candidates for liver transplantation

	Advantages	Disadvantages
Resection	Higher complete effectiveness than non-surgical procedures	Unfeasible in patients with decompensated liver disease or severe portal hypertension
	More simple in cases with peripheral subglissonian nodules
TACE	More effective using the selective/superselective technique in well-vascularized nodules with large feeding arteries	Unfeasible in patients with severely reduced portal vein flow, intratumoral arteriovenous fistula, or renal failure (creatinine clearance < 30 mL/min)
TARE	Possible better effectiveness than TACE in cases with multiple nodules	Less experience with TARE than TACEHigh cost
RFA	More effective in nodules ≤ 3 cm	Potentially dangerous in patients with impaired clotting parameters or lesions located superficially or near the gallbladder, major bile ducts, or bowel loops
PEI	More effective in nodules ≤ 3 cmSuitable in patients with impaired clotting parameters or lesions located in dangerous sites for thermal ablation	Less effective than RFA for nodules > 2 cm
PLA	More effective in nodules ≤ 3 cmSuitable in patients with impaired clotting parameters	Less experience with PLA than RFATechnically complexPotentially dangerous in cases of lesions located superficially or near the gallbladder, major bile ducts, or bowel loops
MWA	Possible better effectiveness than RFA in nodules ≥ 3 cm or located near large vessels	Less experience with MWA than RFAPotentially dangerous in patients with impaired clotting parameters or withlesions located superficially or near the gallbladder, major bile ducts, or bowel loops

TACE: Transarterial chemoembolization; TARE: Transarterial radio embolization; RFA: Radiofrequency ablation; PEI: Percutaneous ethanol injection; PLA: Percutaneous laser ablation; MWA: Microwave ablation.