Hepatotoxicity after Transarterial Chemoembolization and Transjugular Intrahepatic Portosystemic Shunt: Do Two Rights Make a Wrong?

• Published in: Journal of vascular and interventional radiology Vol. 24; no. 1; pp. 68 - 73
• Main Authors: Kohi, Maureen P., Fidelman, Nicholas, Naeger, David M., LaBerge, Jeanne M., Gordon, Roy L., Kerlan, Robert K.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.2013
• Subjects: Aged; Aged, 80 and over; California - epidemiology; Carcinoma, Hepatocellular - mortality; Carcinoma, Hepatocellular - therapy; Chemical and Drug Induced Liver Injury - mortality; Chemoembolization, Therapeutic - mortality; Combined Modality Therapy; Comorbidity; Female; Humans; Incidence; Liver Neoplasms - mortality; Liver Neoplasms - therapy; Male; Middle Aged; Portasystemic Shunt, Transjugular Intrahepatic - mortality; Radiology; Risk Factors; Survival Analysis; Survival Rate; HCC; NCI CTCAE; MELD; CPT; SAE; TIPS; model for end-stage liver disease; severe adverse event; transjugular intrahepatic portosystemic shunt; National Cancer Institute Common Terminology Criteria for Adverse Events; Child-Pugh-Turcotte; hepatocellular carcinoma
• ISSN: 1051-0443; 1535-7732; 1535-7732
• DOI: 10.1016/j.jvir.2012.08.032

To compare the rates of hepatotoxicity after transarterial chemoembolization for hepatocellular carcinoma (HCC) in patients with and without a transjugular intrahepatic portosystemic shunt (TIPS) who were stratified into comparable risk groups. A retrospective review of patients with HCC who were treated with transarterial chemoembolization between January 2005 and December 2009 was performed. Of 158 patients with comparable model for end-stage liver disease (MELD) scores, 10 had a patent TIPS. Hepatobiliary severe adverse events (SAEs) occurring after transarterial chemoembolization were documented. In addition, 1-year survival and liver transplantation rate after transarterial chemoembolization were calculated in each group. The incidence of hepatobiliary SAEs after transarterial chemoembolization was nearly two times higher in patients with a TIPS (70%) than in patients without a TIPS (36%; P=.046). The liver transplantation rate 1 year after transarterial chemoembolization was 2.5 times higher in patients with a TIPS (80%) than in patients without a TIPS (32%; P=.004). There was no significant difference in 1-year survival between the two groups after transarterial chemoembolization. Patients with HCC and a patent TIPS are more likely to develop significant hepatotoxicity after transarterial chemoembolization than comparable patients without a TIPS in place.