Predicting Liver Failure After Locoregional Therapy: Liver Transplantation | May 2026

Introduction:

Locoregional therapy (LRT) is a cornerstone treatment for early- and intermediate-stage hepatocellular carcinoma (HCC), but post-procedure liver dysfunction remains a major concern. This study evaluated which pre-treatment factors best predict liver failure following LRT.

Why was this study needed?

• Liver dysfunction after LRT can limit subsequent treatment options and worsen survival.
• Reliable prediction of post-LRT hepatic decompensation remains challenging.
• The relative importance of liver function versus tumor burden has not been well established.
• Better risk stratification could improve patient selection and peri-procedural planning.
• Simple, clinically applicable predictive tools are needed in routine HCC practice.

Results:

• Baseline liver function scores—including MELD, MELD-Na, and serum bilirubin—were the strongest predictors of liver dysfunction at both 30 and 90 days after LRT.
• Tumor size and demographic characteristics showed limited predictive value, emphasizing that hepatic reserve is more important than tumor burden for short-term outcomes.
• Predictive models demonstrated good discrimination and acceptable calibration, supporting their use for peri-procedural risk assessment.

Clinical Impact:

This study reinforces that hepatic reserve should be the primary determinant when selecting patients for locoregional therapy. Careful assessment using MELD, MELD-Na, and bilirubin may help identify patients at high risk of post-treatment liver failure, enabling individualized treatment planning and closer post-procedure monitoring.

Bottom Line:

In patients undergoing locoregional therapy for HCC, liver function predicts post-treatment liver failure far better than tumor size or patient demographics. Optimizing assessment of hepatic reserve should be central to treatment decision-making.