The current analysis evaluated the application of transarterial radioembolization (TARE) in hepatocellular carcinoma (HCC) both for palliation and as a bridge to liver transplantation. In total, 167 patients underwent 245 TARE sessions, comprising 50 patients in the bridging cohort and 117 in the palliative cohort. Fourteen of these individuals later received liver transplantation (LT). Those who advanced to LT showed significantly better progression-free survival (PFS) than patients who received bridging TARE without subsequent transplantation (P = 0.033). In contrast, no meaningful difference in PFS was observed between the bridging without transplant group and the palliative group (P = 0.116). Following TARE, the median overall survival (OS) reached 16.6 months, with actuarial OS rates of 82.0% at 6 months and 60.5% at 12 months. LT recipients had markedly superior OS compared with the bridging without transplant subgroup (P = 0.001). Outcomes were comparable between the bridging without transplant and palliative cohorts. These observations highlight the clear advantage of LT over alternative approaches. TARE emerged as a valuable tool in cases that did not proceed to transplantation, enabling further lines of therapy. Overall, the study captures the diverse and multifaceted clinical challenges in HCC management and stresses the importance of continued research to optimize integrated multimodal treatment protocols.
