Transarterial chemoembolization and radiological vascular complications.

Abstract

Potential conflict of interest: Nothing to report. TO THE EDITORS: We read with great interest the article entitled “Hepatic Artery and Biliary Complications in Liver Transplant Recipients Undergoing Pretransplant Transarterial Chemoembolization” by Goel et al.,1 which was recently published in Liver Transplantation. The aim of this study was to compare hepatic artery (HA) and biliary complications in recipients of liver transplantation (LT) with hepatocellular carcinoma (HCC) who received transarterial chemoembolization (TACE) before LT and complications in LT recipients with HCC who did not receive TACE before LT. The main biases of this study were (1) the retrospective analysis, (2) the enrollment of patients from 2 different transplant centers, and (3) the great difference in the numbers of patients in the groups [328 of 456 patients (72%) received TACE]. Furthermore, factors that may play a role are (1) the relationship between the number of TACE procedures and HA complications and (2) the length of time between the last TACE procedure and LT. Goel et al.1 concluded that TACE was not associated with higher odds of overall HA complications but was associated with a higher prevalence of HA stenosis. Further studies are warranted to confirm the findings on HA stenosis and to elucidate the pathogenesis. In the literature so far, only Lin et al.2 have shown that TACE is associated with a higher incidence of dissection of the arterial intima in living donor recipients. However, in our article published in 2014,3 we describe a significant relationship between TACE and the occurrence of radiological vascular complications and a statistical association between TACE and histological arterial wall injury. Furthermore, in our study, the pathologists reported different grades of arterial wall injury, such as edema, fibrosis, necrosis, and thrombosis. Despite the limits of our study, we concluded that TACE is related to changes in arterial histology. Therefore, the risk of HCC progression and patient dropout from the list should balance the theoretically increased risk of vascular complications.