Can TACE Be Safely Performed in Transplant Eligible Patients with TIPS?

Purpose: The main purpose of this article is to evaluate the clinical outcomes following transarterial chemoembolization (TACE) in transplant-eligible patients with hepatocellular carcinoma (HCC) who had a patent transjugular intrahepatic portosystemic shunt (TIPS) compared with those without a TIPS.

Materials and Methods: A Institutional Review Board (IRB)-approved retrospective evaluation of consecutive patients with HCC who were eligible for liver transplantation from October 2005 to March 2016 was performed. Thirty patients (median age 59, range 47–74) with TIPS and 118 patients (median age 61, range 36–81) without TIPS were included. Liver transplant rate 1 year after TACE and treatment response based on imaging were compared by Fisher’s exact test. Immediate post-embolization hepatotoxicity was assessed by changes in liver function and compared by unpaired t-test.

Results: There was no significant difference in liver transplantation rate between patients with TIPS and without TIPS at 1 year after TACE (53 vs 44%, p = 0.44). No significant difference was noted in the tumor response rate between TIPS and non-TIPS patients (65 vs 75%, p = 0.19). There was no significant difference in hepatotoxicity between TIPS and non-TIPS patients, as marked by similar changes in total bilirubin (p = 0.33), aspartate aminotransferase (p = 0.37), alanine transaminase (p = 0.23), alkaline phosphates (p = 0.56), platelet count (p = 0.84), and international normalized ratio (p = 0.99) between the two groups.

Conclusion: In transplant eligible patients, TACE may be a safe and effective treatment option for HCC in patients with a patent TIPS.

No conflict of interest has been declared by the author(s).