Increased risk of hepatotoxicity in transarterial chemoembolization patients with poor hepatic reserve

David N Tran
David N Tran

At the scientific session on chemoembolization at the Society of Interventional Radiology’s Annual Meeting (13−18 April 2013, New Orleans, USA), David N Tran, UCSF, San Francisco, USA, spoke to delegates on the topic of transcatheter arterial chemoembolization in liver transplant candidates with and without marginal hepatic reserve.

He said that the purpose of his study was to assess whether, in liver transplant candidates, transcatheter arterial chemoembolization can be used as a stopgap in the time leading up to transplantation and added that during this time patients often have hepatic dysfunction. The aim of their study was to determine the rate of adverse outcomes in their cohort.

From 2005 to 2009, 351 procedures were undertaken in 205 patients. The procedures were categorised as high risk and low risk. The primary outcome was irreversible hepatotoxicity leading to urgent liver transplant or death within six weeks post procedure.

Out of these procedures, 236 were deemed high risk in 133 patients and low risk in 115 procedures (72 patients). Out of the high-risk patients 25 procedures (10.5%) resulted in irreversible hepatotoxicity, of which seven (3%) led to urgent liver transplant. The low-risk cohort only one procedure (0.9%) developed hepatotoxicity with none requiring transplant.

In his conclusion, Tran said that transcatheter arterial chemoembolization can be safely performed in liver transplant candidates with baseline hepatic dysfunction but, in cases where patients have poor hepatic reserve there is an increased risk of irreversible hepatotoxcitiy.

He noted that further study is required to determine specific risk factors for the selection of liver transplant candidates for transcatheter arterial chemoembolization.