Acute Hepatic Failure following Transcatheter Arterial Embolization for the Treatment of Hepatocellular Carcinoma

Abstract

We conducted a retrospective analysis to evaluate the risk factors associated with the occurrence of acute hepatic failure following transcatheter arterial embolization (TAE) for hepatocellular carcinoma. From 1984 to 1993 we performed a total of 623 embolization procedures in 369 patients with both hepatocellular carcinoma and chronic liver disease. Within 2 weeks after TAE, 13 patients (2.1%) experienced hepatic failure as characterized by a rapid increase in serum bilirubin levels and the development of hepatic encephalopathy of grade 2 or higher. These results indicated that the following are risk factors for acute hepatic failure after TAE: poor hepatic functional reserve; high-dose infusion of chemotherapeutic agents, and a history of multiple embolization procedures.

Liver Failure After Transarterial Chemoembolization for Patients With Hepatocellular Carcinoma and Ascites

“…21 In this study, we found that patients with post-TACE hepatic failure had a 2.13-fold increased risk of mortality in the Cox model in comparison with patients without hepatic failure among patients with preexisting ascites receiving TACE. Notably, in this subset of patients, 94% of 17 patients with the development of liver failure died within 1 year of TACE treatment.…”

“…In this study, strikingly, we found that 98 patients with HCC had ascites before TACE and 17 (17.3%) of them developed liver failure after treatment; the incidence of liver failure is higher than those in the reports from other studies. 17,20,21,25 Our results clearly indicate that patients with HCC and ascites are at a substantially higher risk of developing post-TACE liver failure.…”

“…8,19 Pretreatment liver functions are major concerns for patients with HCC receiving TACE because liver failure after TACE is known to be a significant limitation of survival benefit and may be more severe in patient with coexisting liver cirrhosis. 20,21 Earlier randomized controlled trials which achieved a remarkable tumoral response failed to show a clear survival benefit in cirrhotic patients treated with TACE and even questioned this therapy due to a high incidence of post-TACE liver failure. 9,22,23 Therefore, a stricter patient selection was then proposed to reduce the incidence of posttreatment liver failure.…”

Treatment of Hepatocellular Carcinoma

“…Using combined TAE and PEI in the treatment of large HCCs (n = 83), Tanaka et al [52] yielded 35% of 5-year survival. TACE therapy is facing two major problems: TACE increased the risk of pulmonary metastasis, and acute hepatic failure (2.1% in 369 patients) was also reported following TACE [53,54].…”

Renal cortical retention of contrast medium on delayed CT and nephropathy following transcatheter arterial chemoembolisation in patients with high serum creatinine level

“…Contrast associated nephropathy requiring dialysis is rare. Transarterial chemoembolisation (TACE) may also induce nephropathy and, previously, we reported that 1% of patients with hepatocellular carcinoma may develop acute renal failure following TACE [4]. Renal cortical retention (RCR), of contrast medium was suggested as a sign of renal deficiency following the use of contrast medium [5][6].…”