Liver Transplant Bridging: Y-90 Cuts Waitlist Dropout 22% vs TACE

In liver cancer bridging therapy before liver transplant, patients whose first treatment was Y-90 radioembolization (TARE) had a 22% lower risk of dropping off the transplant waiting list than patients treated with chemoembolization (TACE). Researchers at Stanford University and UCSF reached this result by analysing 5,677 patients with hepatocellular carcinoma in the US national transplant database (UNOS), published in the Journal of Hepatology in 2026.

Patients treated with radioembolization needed fewer procedures, and more of them had no living cancer cells left in the liver removed at transplant. This article explains what bridging therapy is, what the new numbers mean, and how the situation looks in Japan and the United States.

Why treat while waiting for a transplant?

A liver transplant can treat liver cancer and the underlying cirrhosis at the same time. In countries that rely on deceased-donor livers, however, the wait often lasts months. If the tumor grows beyond transplant criteria during that time, the patient can be removed from the list. This is called waitlist dropout.

Most patients with liver cancer on the waiting list therefore receive local treatment to keep the tumor in check. Because it carries the patient across to the transplant, it is called bridging therapy. Common options are embolization through the liver artery and needle-based ablation. According to the researchers, nearly all patients with liver cancer awaiting transplant in the US now receive this kind of local treatment.

Terms from Kim NG, et al. J Hepatol 2026, explained in plain language.

Who was compared, and how

Nathan G. Kim of Stanford and Neil Mehta of UCSF used data from the United Network for Organ Sharing (UNOS). The cohort comprised 5,677 adult candidates with an approved liver cancer exception between May 14, 2019 and October 3, 2024 whose first local treatment was either TACE or TARE, split exactly in half.

Since May 2019 the US has scored liver cancer candidates with a single national system, so patients in this period waited under similar rules. The radioembolization group had slightly more patients with a single tumor (76.4% vs 70.5%) and a slightly larger largest tumor, but total tumor burden was similar. The researchers adjusted for liver function and tumor characteristics before comparing outcomes.

22% lower risk of waitlist dropout

After adjustment, patients treated with radioembolization had a 22% lower risk of waitlist dropout than those treated with chemoembolization (hazard ratio 0.78, 95% CI 0.69–0.89). The difference held at one, two and three years.

Cumulative incidence of dropout. Adjusted hazard ratio 0.78 (p<0.001). Kim NG, et al. J Hepatol 2026;84:1112–1120.

Put simply, about 83 of every 100 patients treated with radioembolization stayed on the list over three years, compared with about 78 with chemoembolization. Both treatments carried most patients toward transplant, and radioembolization kept a few more.

What the removed livers showed

Examining the liver removed during transplant shows directly how well treatment worked. Patients treated with radioembolization more often had complete necrosis, with no living cancer cells. More of them also reached transplant after a single local treatment, sparing them repeated procedures.

Kim NG, et al. J Hepatol 2026; summarised in Endovascular Today, October 2026, Year in Review.

The researchers concluded that radioembolization may be the preferred bridging therapy. They added that tumor under-staging, where the real tumor was more advanced than imaging suggested, was also less common after radioembolization.

How TARE and TACE differ

In both procedures a thin tube (catheter) is passed from the groin or wrist artery up to the liver artery. The difference is what is delivered to the tumor.

A general comparison. The actual choice depends on tumor location, size, number and liver function.

See our guide to Y-90 radioembolization and guide to TACE for procedure details. For the wider field see IVR (interventional radiology), and for needle-based treatment see RFA (radiofrequency ablation).

How to read the results

This is an observational study of patients who had already been treated. Eric Wehrenberg-Klee and Suvranu Ganguli, who chose it as a top paper of the year in Endovascular Today (October 2026), noted that tumor location or center experience may have influenced which treatment patients received.

They also explained that a randomized trial with waitlist dropout as its endpoint would be very hard to run. Given consistent results across more than 5,000 patients nationwide, they view the study as supporting the shift toward radioembolization already seen in US practice. Chemoembolization remains a proven treatment that carries many patients to transplant, so the best option depends on each patient's tumor.

Japan and the United States

5-5-500 rule: tumor 5 cm or smaller, 5 or fewer tumors, AFP 500 ng/mL or lower.

In Japan most transplants use part of a liver from a living donor, often a family member, so the situation differs from the long deceased-donor waits in the US. A nationwide study of living-donor transplants at 37 Japanese centers found 5-year overall survival of 81% and 5-year recurrence-free survival of 77% among 485 patients within the Japanese criteria, showing good long-term results for patients transplanted within criteria.

Once the Japanese radioembolization trial is completed, patients preparing for transplant there are expected to gain another option. For consultation abroad, recent contrast CT or MRI, liver function blood tests and tumor markers such as AFP are helpful; see our guide to tests before liver cancer procedures. Foreign patients are often not covered by national insurance, so confirm cost and availability directly with the hospital.

Questions to ask your doctors

• Is my tumor within transplant criteria such as the Milan criteria?
• How long is the expected wait, and which bridging therapy suits me?
• Given my tumor location and liver function, is radioembolization or chemoembolization better?
• When will follow-up scans be done, and how will you decide on retreatment?
• How much experience does this hospital have with radioembolization?

Also see five questions to ask before an RFA consultation.

Frequently asked questions

Do I need treatment while waiting for a liver transplant?

The longer the wait, the more the tumor can grow, so nearly all liver cancer patients awaiting transplant in the US receive bridging therapy. The transplant team decides timing and method based on the expected wait and the tumor.

Is radioembolization always better than chemoembolization?

In the US analysis of 5,677 patients, radioembolization had a 22% lower dropout risk and a higher complete necrosis rate. It is an observational study, and chemoembolization also kept about 78% of patients on the list over three years. Decide with your doctors based on tumor location and liver function.

How many radioembolization sessions are needed?

In this study 80.6% of patients treated with radioembolization reached transplant after a single local treatment. It usually involves one mapping session and one treatment session.

Is radioembolization available in Japan?

A clinical trial to introduce it (NCT07377487) is under way in Japan. Currently, pre-transplant local treatment in Japan mainly uses chemoembolization and radiofrequency ablation, sometimes combined.

This article summarises overseas official sources and studies as general information and is not medical advice. Discuss treatment choices with a doctor who has examined you.