Morbidity and mortality following transarterial liver chemoembolization in patients with hepatocellular carcinoma and synthetic hepatic dysfunction

Departments of Radiology and Biomedical Imaging, University of California San Francisco.
Liver Transplantation (Impact Factor: 4.24). 02/2013; 19(2). DOI: 10.1002/lt.23552
Source: PubMed


PURPOSE: To determine the rate and risk factors for development of irreversible hepatotoxicity following transarterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC) and synthetic hepatic dysfunction. MATERIALS AND METHODS: 251 consecutive patients with HCC and hepatic dysfunction who underwent 443 TACE procedures from 2005 - 2009 were retrospectively reviewed. Included patients met one of the following criteria: pre-TACE bilirubin >2mg/dl, international normalized ratio (INR) >1.5, creatinine >1.2 mg/dL, platelet count <60,000/mL, Model for End-Stage Liver Disease (MELD) score >15, Child-Turcotte-Pugh class B or C, ascites, or portal venous thrombus. Hepatotoxicity was defined as new or worsening ascites, encephalopathy, or NCI Common Terminology Criteria for Adverse Events grade 3 or 4 toxicity of bilirubin, AST, ALT, creatinine or INR. Rate and risk factors for death or urgent liver transplantation within 6 weeks of TACE and irreversible hepatotoxicity were determined using generalized estimating equation analysis. RESULTS: Reversible hepatotoxicity developed after 90 procedures (20%) in 78 patients (31%). Irreversible hepatotoxicity developed after 41 procedures (9%) in 37 patients (15%). Six patients (2%) received urgent liver transplants, and 11 (4%) died within 6 weeks of TACE. Patients at increased risk for procedure-related mortality or urgent liver transplantation within 6 weeks from TACE had baseline serum bilirubin over 4.0mg/dL (p=0.012), elevated INR (p<0.0001), hypoalbuminemia less than 2.0g/L (p=0.014), serum creatinine over 2.0mg/dl (p=0.017), large ascites (p=0.002), encephalopathy (p=0.0047), or MELD >20 (p<0.0004). CONCLUSION: TACE can be performed safely in patients with baseline hepatic dysfunction. However, poor hepatic reserve increases the risk of irreversible hepatotoxicity, which may lead to death or require urgent liver transplantation. Liver Transpl, 2012. © 2012 AASLD.

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    HPB 12/2013; 16(7). DOI:10.1111/hpb.12194 · 2.68 Impact Factor
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