Korean J Gastroenterol.  2007 Sep;50(3):176-182.

Incidence and Risk Factors of Acute Hepatic Failure after Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma

• Jeon SH
• Park KS
• Kim YH
• Shin YS
• Kang MK
• Jang BK
• Chung WJ
• Cho KB
• Hwang JS

Abstract

BACKGROUND/AIMS: Although transcatheter arterial chemoembolization (TACE) is a major treatment modality for unresectable hepatocellular carcinoma (HCC), acute hepatic failure after TACE is not rare. However, reports dealing with this important complication are not good enough and results are often variable. The purpose of this study was to evaluate the incidence and associated risk factors of acute hepatic failure after TACE. METHODS: From January 2001 to November 2004, six hundred and thirtytwo TACE sessions were performed in 377 patients (294 men and 83 women). Adriamycin mixed lipiodol solution and gelfoam were used for TACE. Various clinical and radiological factors before and after the procedure were reviewed retrospectively. Univariate and multivariate analyses were performed to evaluate the risk factors associated with the development of acute hepatic failure after TACE. RESULTS: Acute hepatic failure occurred in 76 (12.0%) of the 632 TACE sessions within 14 days. Univariate analysis revealed that Child-Pugh class, 1st TACE, total bilirubin level, number of involved segments, total size of tumor, presence of right portal vein thrombosis (PVT) or main PVT, involvement of segment 1, 5, 6, 7, modified UICC stage, and doses of chemotherapeutic agent were significantly different between the patients with or without hepatic failure after TACE. Among them, elevated total bilirubin (p=0.001, E (beta)=1.449), presence of right (p=0.035, E (beta)=2.109) or main (p=0.011, E (beta)=4.067) PVT were independently associated factors in multivariate analysis. CONCLUSIONS: The incidence of acute hepatic failure after TACE was 12.0%. Elevated bilirubin level and portal vein thrombosis could be considered as the predictive factors for acute hepatic failure after TACE in HCC patients.

Keyword

Transcatheter arterial chemoembolization; Carcinoma, hepatocellular; Hepatic failure, acute

MeSH Terms

Adult
Aged
Aged, 80 and over
Antibiotics, Antineoplastic/adverse effects/therapeutic use
Carcinoma, Hepatocellular/complications/pathology/*therapy
Chemoembolization, Therapeutic/*adverse effects/methods
Doxorubicin/adverse effects/therapeutic use
Female
Humans
Incidence
Iodized Oil/adverse effects/therapeutic use
Liver Failure, Acute/epidemiology/*etiology
Liver Function Tests
Liver Neoplasms/complications/pathology/*therapy
Male
Middle Aged
Multivariate Analysis
Predictive Value of Tests
Retrospective Studies
Risk Factors
Severity of Illness Index