Correlation of baseline Portal pressure (hepatic venous pressure gradient) and Indocyanine Green Clearance Test With Post-transarterial Chemoembolization Acute Hepatic Failure

Abstract

Background: Liver failure (LF) is a serious complication of transarterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC). This could be influenced by the hemodynamic and functional status of the underlying cirrhotic liver. We evaluated baseline hepatic venous pressure gradient (HVPG) and indocyanine green (ICG) clearance as predictive factors for the development of LF in patients with liver cirrhosis undergoing TACE for HCC. Methods: Forty-two patients with cirrhosis and HCC, referred for TACE, were clinically evaluated including the assessment of Child Turcotte Pugh score (CTP), Model for End-Stage Liver Disease (MELD), HVPG measurement, and ICG retention test. Predictors of development of hepatic failure after TACE were determined. Results: In our study population, the mean age of the patients was 58 years, with mean CTP of 6.60 ± 1.149 and mean MELD score of 9.57 ± 2.923. The mean HVPG and ICG retention at 15 min was 13.57 ± 4.64 mmHg and 21.571 ± 12.434, respectively. Post-TACE Liver Failure (PTLF within 1 month after TACE) developed in 23.80% patients, whereas 76.19% patients did not have PTLF. The statistically significant preprocedure variables that might predict hepatic failure after TACE using univariate analysis were found to be high CTP, MELD score, ICG retention, HVPG, serum bilirubin, serum creatinine, alfa-fetoprotein levels, large tumor size, and low baseline serum albumin. On multivariate analysis, ICG was an independent factor predictive of hepatic failure after TACE. Conclusion: Pretreatment evaluation of routine liver function is of fundamental importance before TACE. Baseline ICG retention test (ICG-R15) is a marker indicating the state of liver function in patients undergoing TACE and is an independent predictor for PTLF. Our study concludes that with a cutoff of 25, ICG-R15 has 92.9% accuracy, 90% sensitivity, and 87.5% specificity to predict hepatic failure after TACE.

Volume–Function Analysis (LiMAx Test) in Patients with HCC and Cirrhosis Undergoing TACE—A Feasibility Study

“…Therefore, other additional tests were developed in order to reduce the PTHF rate. Huang et al [23] showed the superiority of the monoethylglycinexylidide test over conventional liver function tests and clinical parameters to predict PTHF. Similarly, Khisti et al [24] showed a specificity of 87.5% and sensitivity of 90% for the liver function test with indocyanine green clearance to predict PTHF.…”

Higher indocyanine green retention rates predicted improved prognoses in hepatocellular carcinoma patients treated with transcatheter arterial chemoembolization

“…In patients treated with TACE, post therapeutic ICG-R15 presented higher values compared to the baseline [40]. Moreover, higher ICG-R15 at baseline suggests a greater risk of acute liver failure after TACE [41,42]. The safety dose of iodized oil in the TACE procedure was limited in patients with ICG-R15>20% [43].…”

Risk factors for Hepatic failure after Transarterial Chemoembolization in patients with Hepatocellular carcinoma: A Systematic Review and Meta-Analysis

“…Ultimately, nine studies were included in the meta-analysis. All of the studies are retrospective case-control studies [13,15,16,[19][20][21][22][23][24], with a total of 1,654 patients. The study review and literature review process are shown in Figure 1.…”