Y-90 transarterial radioembolization (TARE) has become the leading bridging therapy for liver transplant candidates with hepatocellular carcinoma in the U.S., accounting for 45.8% of all liver-directed procedures by 2025 due to superior outcomes, fewer required treatments, and strong clinical evidence supporting complete tumor control.
- Y-90 TARE surpassed all other locoregional treatments for liver transplant candidates with hepatocellular carcinoma, becoming the dominant bridging therapy by 2023
- By 2025, TARE accounted for 45.8% of 2,653 liver-directed therapy procedures, nearly triple the share of chemoembolization at 17.6%
- TARE utilization rose sharply starting in 2012, coinciding with mounting clinical evidence and pivotal trials showing high rates of complete pathologic necrosis
- Key advantages include outpatient administration, fewer treatments required than traditional chemoembolization, and personalized technical approaches
- Liver transplantation remains the only curative option for cirrhosis and hepatocellular carcinoma, making effective bridging therapy essential to maintain transplant eligibility
Yttrium-90 transarterial radioembolization (Y-90 TARE) has surpassed all other locoregional treatments for liver transplant candidates with hepatocellular carcinoma (HCC) in the U.S., according to a recent report.
A group from Northwestern University in Chicago analyzed updated Organ Procurement and Transplantation Network (OPTN) data through 2025, with findings suggesting that TARE has emerged as a new standard of care for bridging therapy in liver transplant candidates.
"Supported by biological rationale, technological innovation, explant pathology, and superior transplant-related outcomes, TARE has transitioned from an alternative therapy to the dominant bridging strategy in the United States," noted lead author Riad Salem, MD, and colleagues. The findings were published September 3 in the Journal of Vascular and Interventional Radiology.
Liver transplantation remains the only curative option for patients with cirrhosis and HCC, the authors wrote. Because tumor progression can compromise transplant eligibility, locoregional therapy has become an essential cornerstone of transplant oncology, they noted.
To assess the changing landscape in the field, the researchers drew on OPTN data tracking bridging therapies in liver transplant recipients across more than two decades, with the updated analysis based on OPTN records as of July 5, 2026.
According to the analysis, between 2005 and 2012, transarterial chemoembolization (TACE) and radiofrequency ablation accounted for a vast majority of bridging treatments. TARE utilization began rising sharply in 2012, coincident with rapidly mounting clinical evidence, and by 2023 had surpassed all other treatments as the most frequently used bridging therapy, they added.
By 2025, TARE accounted for 45.8% of 2,653 liver-directed therapy procedures, nearly triple the share of chemoembolization, which fell to 17.6%. Thermal ablation ranked second at 24.8%, while external beam radiation accounted for 5.5% of procedures. All other modalities comprised the remainder.
"TARE has established a distinct and increasingly central role within transplant oncology," the group wrote.
The reasons for the transition include that TARE is performed in the outpatient setting, requires fewer treatments than TACE, and technically has evolved towards a personalized approach. Also, the treatment is supported by pivotal trials showing that it leads to durable tumor control with high rates of complete pathologic necrosis.
Other locoregional modalities continue to play important roles, the researchers noted. Advances in image guidance have expanded the reach of thermal ablation, and stereotactic body radiation therapy remains an option for select patients.
"The 2025 OPTN data appear to capture not only a changing treatment preference, but the emergence of a new standard of care," the group concluded.
The full study is available here.
