8:16 AM Abstract No. 130 - Hepatotoxicity and mortality following transarterial chemoembolization with doxorubicin-eluting beads in patients with hepatocellular carcinoma and marginal hepatic reserve

Abstract

Purpose To determine incidence and risk factors of irreversible hepatotoxicity after transarterial chemoembolization (TACE) with doxorubicin-eluting beads (DEB) for hepatocellular carcinoma (HCC) in a patient population with high prevalence of hepatic dysfunction. Materials and Methods Records of 48 consecutive patients with HCC who underwent 76 DEB-TACE procedures from 2011-2012 were retrospectively reviewed. Forty-seven (60.3%) and 26 (33.3%) of the procedures were performed in patients with total bilirubin of >2mg/dl and >3mg/dl respectively. Mean Model for End-Stage Liver Disease (MELD) score prior to TACE was 12.7 (median 13, standard deviation 4.0). Portal vein thrombus, hepatofugal flow, or transjugular intrahepatic portosystemic shunt (TIPS) was present prior to 17 procedures (21.8%). Thirty procedures (38.5%) were performed in patients with ascites. TACE was delivered to a segmental or subsegmental hepatic artery (50 procedures; 64.1%), two segmental hepatic arteries (23; 29.5%), or three segmental arteries (3; 3.8%). Hepatotoxicity was defined as new or worsening ascites or NCI Common Terminology Criteria for Adverse Events grade 3 or 4 toxicity of bilirubin, AST, ALT, creatinine or INR. Rates for death or urgent liver transplantation within 6 weeks of DEB TACE and irreversible hepatotoxicity were determined. Results Reversible hepatotoxicity developed after 13 procedures (16.7%) in 10 patients (20.8%). Irreversible hepatotoxicity developed after 11 procedures (14.1%) in 11 patients (22.9%). One patient required an urgent liver transplant in the setting of irreversible hepatotoxicity within 6 weeks of DEB-TACE. No patient died within 6 weeks of DEB-TACE. Conclusion DEB-TACE can be performed safely in patients with baseline hepatic dysfunction.