Liver Function Dominates Risk Prediction After HCC Locoregional Therapy : Liver Transpl | May 2026

Introduction

Locoregional therapy (LRT) remains a cornerstone treatment strategy for patients with early- and intermediate-stage Hepatocellular Carcinoma. Although procedures such as transarterial chemoembolization and ablative therapies are routinely performed, post-procedural hepatic decompensation remains a major determinant of morbidity, treatment interruption and mortality. Identifying patients at highest risk for short-term liver dysfunction is therefore essential for treatment selection and peri-procedural planning.

Problem Statement

Current risk assessment for LRT often incorporates tumor burden, demographic variables and clinician judgment, but the relative contribution of hepatic reserve versus tumor-related factors in predicting post-LRT liver failure remains uncertain. Reliable prediction models for short-term hepatic dysfunction following LRT are still lacking in routine clinical practice.

Summary

This retrospective Veterans Health Administration cohort study evaluated 1,183 patients with early- to intermediate-stage HCC undergoing locoregional therapy to determine predictors of severe liver dysfunction within 30 and 90 days after treatment. Multiple clinical, laboratory and tumor-related variables were assessed for prognostic performance using discrimination and calibration analyses.

Measures of baseline hepatic reserve consistently outperformed tumor-related and demographic factors in predicting post-LRT liver dysfunction. Among all evaluated metrics, the MELD=3.78ln(bilirubin)+11.2ln(INR)+9.57ln(creatinine)+6.43 score demonstrated the strongest predictive discrimination for both 30-day and 90-day outcomes, followed closely by MELD-Na and serum bilirubin levels. In contrast, total tumor diameter and demographic characteristics provided limited prognostic value. Model calibration remained acceptable across multiple risk strata, supporting the robustness of liver function–based prediction approaches.

The findings reinforce the concept that hepatic reserve, rather than tumor burden alone, is the principal determinant of peri-procedural vulnerability following LRT. Even among patients with relatively early-stage HCC, impaired baseline liver function substantially increased the likelihood of post-treatment decompensation. These data support prioritization of liver severity metrics when selecting candidates for locoregional therapies and may help refine multidisciplinary decision-making regarding treatment intensity, monitoring and transplant referral timing.

Overall, this study provides important real-world evidence that objective liver function assessment should remain central to procedural risk stratification in HCC and highlights the need for future prospective models integrating dynamic hepatic reserve measurements into LRT treatment algorithms.