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CC BY 4.0 · Journal of Clinical Interventional Radiology ISVIR 2024; 08(02): 083-089
DOI: 10.1055/s-0044-1786711
Original Article

Predictors of Hepatic Decompensation after Yttrium90 Transarterial Radioembolization—Optimizing Patient Selection

Amelia Wong 
1   Department of Surgery, University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii, United States
,
Shirley Cheng 
2   John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii, United States
,
Anthony Herrera
3   Department of Radiology, The Queen's Medical Center, Honolulu, Hawaii, United States
,
Linda Wong 
1   Department of Surgery, University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii, United States
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Abstract

Purpose Yttrium 90 (Y90) transarterial radioembolization (TARE) is effective for unresectable hepatocellular carcinoma (HCC) or to bridge/downstage before transplant; however, optimal patient selection is not well-described. This study aims to identify factors that increase risk of liver decompensation resulting in hospital admissions after TARE.

Methods Patients who received Y90 as their first treatment during 2012 to 2022 were identified from a prospectively collected database of 1675 HCC patients. Clinically significant hepatic decompensation was defined as total bilirubin more than or equal to 3 mg/dL or any increase in Model for End-stage Liver Disease (MELD) score resulting in readmission within 60 days or death.

Results Of 137 patients, 7 (5.1%) developed hepatic decompensation requiring admission within 30 days and an additional 8 (10.9%) within 60 days. Two of these patients (1.4%) died and two (1.4%) required urgent transplant within 2 months. Preprocedure albumin less than 3.5 gm/dL (p = 0.0207), international normalized ratio more than 1.2 (p = 0.017), ascites (p = 0.036), elevated MELD (p = 0.012), and Child-Pugh (p = 0.007) scores were significant predictors of decompensation, while creatinine and sodium were not. Patients with Child-Pugh B score were three to four times more likely to decompensate (28 vs. 8%) compared to Child-Pugh A. For every unit increase in Child-Pugh score more than 6, odds of decompensation increased by a factor of 2.15.

Conclusion Y90 TARE is safe and effective; however, 10.9% patients require readmission for worsened liver function. Because ascites is a significant factor in predicting decompensation and all patients require adequate renal function to receive Y90 TARE, Child-Pugh score may be more useful than MELD for patient selection. Further risk stratification may be required for those with a Child-Pugh score more than or equal to 7.

Keywords

hepatocellular carcinoma - yttrium 90 - transarterial radioembolization

Ethical approval

This study was approved by the Institutional Review Board of The Queen's Medical Center and complies with ethical regulations.




Publication History

Article published online:
13 May 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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