Repeated transcatheter arterial chemoembolization is safe for hepatocellular carcinoma in cirrhotic patients with transjugular intrahepatic portosystemic shunt.

Abstract

We aimed to investigate the safety and long-term outcomes of repeated transcatheter arterial chemoembolization (TACE) in cirrhotic patients with transjugular intrahepatic portosystemic shunt (TIPS). Data of patients with hepatocellular carcinoma, who had previous TIPS implantation and received TACE between January 2010 and December 2012, were reviewed retrospectively. The primary outcome measure was liver function, which was represented by model for end-stage liver disease score, Child-Pugh-Turcotte score, serum total bilirubin, alanine aminotransferase, and aspartate aminotransferase. Changes in liver function before and after the initial TACE procedure and hepatobiliary severe adverse events (SAEs) were compared. Liver function following the initial TACE session was compared with that obtained in later TACE sessions. The secondary outcome measures were tumor response to multiple TACE sessions and survival. Seventeen patients underwent at least two TACE sessions, while nine patients underwent at least three sessions during the follow-up period. There was no statistically significant difference between the liver function tests performed before and one-month after the TACE procedure. Grade 3 or 4 SAEs occurred in six (31.6 %) patients within one month. The one, two-, and three-year survival rates were 88%, 53%, and 32%, respectively. Tumor response of multiple TACE sessions was the only predictive risk factor of mortality (OR=4.40; P = 0.030; 95% CI, 1.15-16.85). Our results suggest that repeated TACE is safe in selected patients with TIPS.