Sa1840 Effects of Oral L-Carnitine on Liver Functions After Transarterial Chemoembolization (TACE) in Intermediate Stage Hepatocellular Carcinoma (HCC) Patients.

Abstract

Background :Transarterial chemoembolization (TACE) is the standard treatment for intermediate stage hepatocellular carcinoma (HCC) and usually followed by hepatic dysfunction that limits its efficacy. L-carnitine (4-N-trimethyl ammonium 3-hydroxybutyric acid) is recently studied as hepatoprotective agent. In this study, we evaluated L-carnitine effects against the deterioration in liver functions after TACE. Study design: 53 sequential patients with intermediate stage HCC at Osaka Medical College enrolled to this study. All patients were treated by TACE and assigned into two groups; L-carnitine group (26 patients) who received L-carnitine 300 mg tablet twice daily from 2 weeks before to 12 weeks after TACE and Control group (27 patients) without L-carnitine therapy. Liver functions were evaluated for all patients at 2 weeks before, 1, 4, 12 weeks after TACE. 28 of study patients received branched chain amino acids granules. Results: L-carnitine suppressed deterioration in serum albumin level at 1 week after TACE. There were significant differences between L-carnitine group and control group in mean serum albumin change from baseline to 1 week and 4 weeks after TACE (p < 0.05). L-Carnitine maintained Child-Pugh score at 1 week after TACE and exhibited significant improvement at 4 weeks after TACE (p < 0.01 compared to 1 week after TACE). Conversely, control group reported significant Child-Pugh score deterioration from baseline to 1 week after TACE (p < 0.05) and 12 weeks after TACE (p < 0.05). There were significant differences between L-carnitine and control groups in mean Child-Pugh score change from baseline to 4 weeks (p < 0.05) and 12 weeks after TACE (p < 0.05). Interestingly, L-carnitine displayed improvement in prothrombin time (PT) from baseline to 1 week, 4 weeks (p < 0.05) and 12 weeks after TACE. Contrariwise, PT in control group declined less than baseline along all follow up intervals. There were significant differences between L-carnitine and control groups in PT mean change from baseline to 1 week (p < 0.05) and 4 weeks after TACE (p < 0.05). Total bilirubin in L-carnitine group decreased at 1 week post TACE while in control group, total bilirubin at 1 week significantly increased (p = 0.01). Mean total bilirubin change from baseline to 1 week after TACE reported significant differences between L-carnitine and control groups (p < 0.05). Alanine transaminase and C-reactive protein elevation at 1 week after TACE were suppressed in Lcarnitine group. The hepatoprotective effects of L-carnitine were enhanced by concomitant use of branched chain amino acids. No side effects appeared by L-carnitine administration in all clinical courses. Conclusion: L-carnitine and BCAA combination therapy maintained and improved liver functions after TACE and may be offered as a new liver support tool in HCC patients.