The impact of transarterial chemoembolization induced complications on outcomes after liver transplantation: A propensity‐matched study

Boteon, Amanda Pinter Carvalheiro da Silva; Boteon, Yuri L.; Viñuela, Eduardo; Derosas, C.; Mergental, Hynek; Isaac, John; Muiesan, Paolo; Mehzard, Homoyoon; Ting, Yuk; Shah, Tahir; Mirza, Darius F.; Perera, M. Thamara P. R.

doi:10.1111/ctr.13255

Cited by 12 publications

(4 citation statements)

References 34 publications

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“…However, we adjusted for a wide range of characteristics and therefore, it is unlikely that changes over time in recipient and donor characteristics explain the large reduction in post-transplant outcomes in recipients of DCD livers. Second, the frequency of HAT and biliary complications in the first 3 months following transplantation may be an underestimate of their true frequency, as it is known that they can be difficult to detect 38 . However, we note that the frequency of complications that we found is consistent with other studies 39 .…”

Section: Discussionmentioning

confidence: 99%

National time trends in mortality and graft survival following liver transplantation from circulatory death or brainstem death donors

Wallace

Cowling

Suddle

et al. 2021

British Journal of Surgery

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Background Despite high waiting list mortality rates, concern still exists on the appropriateness of using livers donated after circulatory death (DCD). We compared mortality and graft loss in recipients of livers donated after circulatory or brainstem death (DBD) across two successive time periods. Methods Observational multinational data from the United Kingdom and Ireland were partitioned into two time periods (2008–2011 and 2012–2016). Cox regression methods were used to estimate hazard ratios (HRs) comparing the impact of periods on post-transplant mortality and graft failure. Results A total of 1176 DCD recipients and 3749 DBD recipients were included. Three-year patient mortality rates decreased markedly from 19.6 per cent in time period 1 to 10.4 per cent in time period 2 (adjusted HR 0.43, 95 per cent c.i. 0.30 to 0.62; P < 0.001) for DCD recipients but only decreased from 12.8 to 11.3 per cent (adjusted HR 0.96, 95 per cent c.i. 0.78 to 1.19; P = 0.732) in DBD recipients (P for interaction = 0.001). No time period-specific improvements in 3-year graft failure were observed for DCD (adjusted HR 0.80, 95% c.i. 0.61 to 1.05; P = 0.116) or DBD recipients (adjusted HR 0.95, 95% c.i. 0.79 to 1.14; P = 0.607). A slight increase in retransplantation rates occurred between time period 1 and 2 in those who received a DCD liver (from 7.3 to 11.8 per cent; P = 0.042), but there was no change in those receiving a DBD liver (from 4.9 to 4.5 per cent; P = 0.365). In time period 2, no difference in mortality rates between those receiving a DCD liver and those receiving a DBD liver was observed (adjusted HR 0.78, 95% c.i. 0.56 to 1.09; P = 0.142). Conclusion Mortality rates more than halved in recipients of a DCD liver over a decade and eventually compared similarly to mortality rates in recipients of a DBD liver. Regions with high waiting list mortality may mitigate this by use of DCD livers.

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Section: Discussionmentioning

confidence: 99%

National time trends in mortality and graft survival following liver transplantation from circulatory death or brainstem death donors

Wallace

Cowling

Suddle

et al. 2021

British Journal of Surgery

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“…The frequency of HAT and biliary complications following transplantation that we observed in our study may represent an underestimation of their true frequency. 4 These post-transplantation complications, although known to be rare, can be quiescent in their clinical presentation, especially HAT where the rapid development of collateral circulation can quickly compensate for occlusion of the hepatic artery. 21 Therefore, the small number of these complications that were identified in the Standard National Liver Transplant Registry may have precluded us from being able to detect significant differences between those receiving TACE and those who did not.…”

Section: Methodological Limitationsmentioning

confidence: 99%

“…3 The procedure can induce decompensation of the cirrhotic liver and can also cause damage to the inner lining or the intima of the hepatic artery, potentially increasing the risk of hepatic artery thrombosis (HAT). [3][4][5] A recent systematic review representing 1 122 patients from 14 retrospective studies, found that TACE increased the overall risk of hepatic artery complications after liver transplantation. (5) So far, there is no evidence that the use of TACE in HCC patients on the waiting list for transplantation has an impact on post-transplant survival.…”

Section: Introductionmentioning

confidence: 99%

Liver transplantation outcomes after transarterial chemotherapy for hepatocellular carcinoma

Wallace

Cowling

Walker

et al. 2020

British Journal of Surgery

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Background Transarterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC) awaiting liver transplantation is widespread, although evidence that it improves outcomes is lacking and there exist concerns about morbidity. The impact of TACE on outcomes after transplantation was evaluated in this study. Methods Patients with HCC who had liver transplantation in the UK were identified, and stratified according to whether they received TACE between 2006 and 2016. Cox regression methods were used to estimate hazard ratios (HRs) for death and graft failure after transplantation adjusted for donor and recipient characteristics. Results In total, 385 of 968 patients (39·8 per cent) received TACE. Five-year patient survival after transplantation was similar in those who had or had not received TACE: 75·2 (95 per cent c.i. 68·8 to 80·5) and 75·0 (70·5 to 78·8) per cent respectively. After adjustment for donor and recipient characteristics, there were no differences in mortality (HR 0·96, 95 per cent c.i. 0·67 to 1·38; P = 0·821) or graft failure (HR 1·01, 0·73 to 1·40; P = 0·964). The number of TACE treatments (2 or more versus 1: HR 0·97, 0·61 to 1·55; P = 0·903) or the time of death after transplantation (within or after 90 days; P = 0·291) did not alter the outcome. The incidence of hepatic artery thrombosis was low in those who had or had not received TACE (1·3 and 2·4 per cent respectively; P = 0·235). Conclusion TACE delivered to patients with HCC before liver transplant did not affect complications, patient death or graft failure after transplantation.

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“…BDN is less frequent in liver transplantation. This is due to the fact that retrograde blood flow from the portal system maintains PBP blood flow, even after the disruption of hepatic arterial blood flow toward the PBP in the case of arterial blood flow impairment during liver transplantation [ 32 , 33 , 34 ]. In contrast, in TACE and HAIC, bile duct epithelial injury is more pronounced because the PBP itself is impaired and blood flow within the PBP is intercepted [ 3 , 35 ].…”

Section: Pathophysiology Of Bdn After Transcatheter Therapymentioning

confidence: 99%

Pathophysiology and Imaging Findings of Bile Duct Necrosis: A Rare but Serious Complication of Transarterial Therapy for Liver Tumors

Kobayashi

Kozaka

Gabata

et al. 2020

Cancers

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Bile duct necrosis (BDN) with biloma formation is a type of ischemic bile duct injury that is one of the serious complications associated with transarterial therapies, such as transcatheter chemoembolization therapy (TACE), and radioembolization for hepatocellular carcinoma (HCC) and hepatic arterial infusion chemotherapy (HAIC) for metastatic liver cancer from colorectal carcinoma. In terms of the occurrence of BDN and subsequent biloma formation, ischemic injury to the peribiliary vascular plexus (PBP), the supporting vessel of bile duct epithelium, is thought to be intimately associated. In this paper, we first describe the anatomy, blood supply, and function of the intrahepatic bile duct, and then illustrate the pathophysiology of BDN, and finally present the imaging findings of BDN. Under the process of BDN formation, ischemia of the PBP induces the disruption of the bile duct epithelial protection mechanism that causes coagulation and fibrinoid necrosis of the surrounding tissue by the detergent action of exuded bile acids, and eventually a biloma forms. Once BDN occurs, persistent tissue damage to the surrounding bile duct is induced by imbibed bile acids, and portal vein thrombosis may also be observed. On pre-contrast and contrast-enhanced computed tomography (CT), BDN shows similar findings to intrahepatic bile duct dilatation, and, therefore, it is sometimes misdiagnosed. Differentiation of imaging findings on CT and ultrasound (US)/magnetic resonance (MR) imaging/MR cholangiopancreatography (MRCP) is important for correct diagnosis of BDN.

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The impact of transarterial chemoembolization induced complications on outcomes after liver transplantation: A propensity‐matched study

Abstract: TACE was an effective bridging procedure that may complicate LT inducing ischemic-related complications; nevertheless, it has not shown repercussions on mortality or morbidity after the procedure, even using donors after circulatory death.

Cited by 12 publications

References 34 publications

National time trends in mortality and graft survival following liver transplantation from circulatory death or brainstem death donors

National time trends in mortality and graft survival following liver transplantation from circulatory death or brainstem death donors

Liver transplantation outcomes after transarterial chemotherapy for hepatocellular carcinoma

Pathophysiology and Imaging Findings of Bile Duct Necrosis: A Rare but Serious Complication of Transarterial Therapy for Liver Tumors

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