Abstract No. 314: Transarterial hepatic chemoembolization in patients who have previously undergone TIPS

PurposePatients who have undergone TIPS for portal hypertension are not considered ideal candidates for treatment of hepatocellular carcinoma (HCC) with TACE. There is concern that TACE will lead to hepatic function deterioration in patients who have diversion of portal blood flow via a TIPS. The objective of this retrospective review is to evaluate the safety of performing TACE in patients with TIPS through use of the Model for End-Stage Liver Disease (MELD) scoring system both pre and post TACE.Materials and MethodsA retrospective review of the radiology information system was conducted to identify all patients with TIPS who had undergone TACE procedures from 2004 through 2008. 9 patients (9/9 males; age range, 50.3 - 73.1y; median age, 56.1y) were identified and had undergone a total of 16 TACE procedures. Prior to TACE, all patients had pre-procedure labs to allow for calculation of the pre-procedure MELD score. Patency of TIPS at the time of the TACE was confirmed in all patients either on portal venous phase imaging during angiography or with Doppler ultrasound. TACE was performed using Adriamycin, Ethiodol, and tris-acryl gelatin microspheres. All patients were admitted overnight following TACE and follow-up labs were obtained on all patients at one month post-TACE to calculate the post-procedure MELD score. The mean follow- up time after TACE was 15.6 months (range, 2 months- 46 months).ResultsRetrospective review of the laboratory data allowed for calculation of pre and post TACE MELD scores in a total of 16 TACEs among 9 patients. A mean pre-procedure MELD score of 15.5 (range 10-34, standard deviation 5.7) was observed. The mean post-procedure MELD score was observed as 15.2 (range 8-30, standard deviation 5.4). Statistical analysis of MELD scores pre and post-TACE fails to demonstrate any significant change (paired t-test value of 0.38) in liver function among patients who undergo TACE subsequent to placement of TIPS. In addition, survival at 6, 12, and 15 months post TACE was 78%, 56% and 33%, respectively.ConclusionThese preliminary results suggest it is safe for patients with pre-existing TIPS to undergo subsequent treatment for HCC with TACE. PurposePatients who have undergone TIPS for portal hypertension are not considered ideal candidates for treatment of hepatocellular carcinoma (HCC) with TACE. There is concern that TACE will lead to hepatic function deterioration in patients who have diversion of portal blood flow via a TIPS. The objective of this retrospective review is to evaluate the safety of performing TACE in patients with TIPS through use of the Model for End-Stage Liver Disease (MELD) scoring system both pre and post TACE. Patients who have undergone TIPS for portal hypertension are not considered ideal candidates for treatment of hepatocellular carcinoma (HCC) with TACE. There is concern that TACE will lead to hepatic function deterioration in patients who have diversion of portal blood flow via a TIPS. The objective of this retrospective review is to evaluate the safety of performing TACE in patients with TIPS through use of the Model for End-Stage Liver Disease (MELD) scoring system both pre and post TACE. Materials and MethodsA retrospective review of the radiology information system was conducted to identify all patients with TIPS who had undergone TACE procedures from 2004 through 2008. 9 patients (9/9 males; age range, 50.3 - 73.1y; median age, 56.1y) were identified and had undergone a total of 16 TACE procedures. Prior to TACE, all patients had pre-procedure labs to allow for calculation of the pre-procedure MELD score. Patency of TIPS at the time of the TACE was confirmed in all patients either on portal venous phase imaging during angiography or with Doppler ultrasound. TACE was performed using Adriamycin, Ethiodol, and tris-acryl gelatin microspheres. All patients were admitted overnight following TACE and follow-up labs were obtained on all patients at one month post-TACE to calculate the post-procedure MELD score. The mean follow- up time after TACE was 15.6 months (range, 2 months- 46 months). A retrospective review of the radiology information system was conducted to identify all patients with TIPS who had undergone TACE procedures from 2004 through 2008. 9 patients (9/9 males; age range, 50.3 - 73.1y; median age, 56.1y) were identified and had undergone a total of 16 TACE procedures. Prior to TACE, all patients had pre-procedure labs to allow for calculation of the pre-procedure MELD score. Patency of TIPS at the time of the TACE was confirmed in all patients either on portal venous phase imaging during angiography or with Doppler ultrasound. TACE was performed using Adriamycin, Ethiodol, and tris-acryl gelatin microspheres. All patients were admitted overnight following TACE and follow-up labs were obtained on all patients at one month post-TACE to calculate the post-procedure MELD score. The mean follow- up time after TACE was 15.6 months (range, 2 months- 46 months). ResultsRetrospective review of the laboratory data allowed for calculation of pre and post TACE MELD scores in a total of 16 TACEs among 9 patients. A mean pre-procedure MELD score of 15.5 (range 10-34, standard deviation 5.7) was observed. The mean post-procedure MELD score was observed as 15.2 (range 8-30, standard deviation 5.4). Statistical analysis of MELD scores pre and post-TACE fails to demonstrate any significant change (paired t-test value of 0.38) in liver function among patients who undergo TACE subsequent to placement of TIPS. In addition, survival at 6, 12, and 15 months post TACE was 78%, 56% and 33%, respectively. Retrospective review of the laboratory data allowed for calculation of pre and post TACE MELD scores in a total of 16 TACEs among 9 patients. A mean pre-procedure MELD score of 15.5 (range 10-34, standard deviation 5.7) was observed. The mean post-procedure MELD score was observed as 15.2 (range 8-30, standard deviation 5.4). Statistical analysis of MELD scores pre and post-TACE fails to demonstrate any significant change (paired t-test value of 0.38) in liver function among patients who undergo TACE subsequent to placement of TIPS. In addition, survival at 6, 12, and 15 months post TACE was 78%, 56% and 33%, respectively. ConclusionThese preliminary results suggest it is safe for patients with pre-existing TIPS to undergo subsequent treatment for HCC with TACE. These preliminary results suggest it is safe for patients with pre-existing TIPS to undergo subsequent treatment for HCC with TACE.