Efficacy of Transarterial Radioembolization and Transarterial Chemoembolization as Downstaging or Bridging Strategies for Hepatocellular Carcinoma Before Liver Transplantation: A Systematic Review and Meta-Analysis.

[PURPOSE] This study aimed to compare transarterial radioembolization (TARE) and transarterial chemoembolization (TACE) as locoregional therapies (LRT) for HCC patients awaiting liver transplantation (LT).

[MATERIALS AND METHODS] We conducted a systematic review with meta-analysis by searching PubMed, Embase, Web of Science, and Cochrane Library databases from inception until October 22, 2025. Twelve studies involving 10,661 patients were included. Studies comparing TARE and TACE for downstaging or bridging to LT in HCC patients were included. The primary outcome was downstaging rate. The protocol for this review was registered with PROSPERO under ID: CRD420251183741.

[RESULTS] The analysis demonstrated no significant differences between TARE and TACE in key outcomes such as downstaging rate (OR 0.96; 95% CI 0.60-1.54; P = 0.88), transplantation rate (OR 0.89; 95% CI 0.66-1.21; P = 0.47), and recurrence rate (OR 1.26; 95% CI 0.69-2.28; P = 0.45). However, TARE was associated with fewer LRT sessions (MD -0.66; 95% CI -1.01 to -0.31; P = 0.0002), lower incidence of grade 3/4 bilirubin toxicities (OR 0.32; 95% CI 0.11-0.91; P = 0.03), and higher rates of complete tumor necrosis (OR 2.16; 95% CI 1.14-4.09; P = 0.02). Although no significant differences were observed in 1-year, 2-year, and 3-year overall survival (all p > 0.05), the pooled odds ratios consistently favored TARE (all OR > 1). Additionally, recurrence-free survival was significantly superior with TARE (OR 2.39; 95% CI 1.11-5.16; P = 0.03).

[CONCLUSIONS] While TARE and TACE demonstrate comparable efficacy in downstaging or bridging patients to LT, TARE may offer practical clinical advantages due to its enhanced oncologic efficacy, fewer treatment sessions, and a more favorable safety profile.