Safety of Drug-Eluting Beads Chemoembolization in Patients with Pre-Exisiting Transjugular Intrahepatic Portosystemic Shunt

STUDY AIM: To assess the safety of transarterial chemoembolization (TACE) for unresectable hepatocellular carcinoma (HCC) in patients with a pre-existing transjugular intrahepatic portosystemic shunt (TIPS). METHODS: A multi-institutional, IRB approved, retrospective review was conducted of patients with a pre-existing patent TIPS who underwent TACE to treat unresectable HCC between 2009 and 2014. Patients (7 male, 4 female) ranging from 39 to 74 years of age (mean 61, SD 11) were included. Parameters of interest included type of TACE (drug-eluting beads or traditional), number of TACE procedures, 30-day mortality from last TACE procedure, and any complications or toxicity following TACE. RESULTS:Ten of the eleven patients underwent super-selective drug-eluting bead TACE, using doxorubicin at a dosage ranging from 50mg to 150mg (Median 100mg). Number of TACE procedures per patient ranged from 1 to 4 (Median 1). Three of the patients (3/11, 27%) experienced toxicity (CTAE v4) grade 2 or higher immediately following the TACE procedure. Two of these patients experienced Grade 2 Albumin Toxicity. Another had Grade 3 Toxicity of AST, ALT and bilirubin. 73% of patients were discharged within 24 hours. The remaining 3 patients were hospitalized for pain, edema, or acute pancreatitis for 3, 5 and 20 days respectively. All eleven patients were alive and discharged from the hospital 30 days after the most recent TACE procedure. DISCUSSION: TACE can be well tolerated by patients with a patent TIPS given adequate liver function. As additional cases are performed we hope to clarify the efficacy and most appropriate TIPS patient population for TACE.