Acute portal hemodynamics and cytokine changesfollowing selective transarterial chemoembolization in patients with cirrhosis and hepatocellular carcinoma.
BACKGROUND
Altered portal hemodynamics and inflammation may occur following transcatheter arterial chemoembolization (TACE), but early biological and portal perfusion changes are not well characterized when this procedure is performed selectively.


METHODS
We studied variations in portal flow velocity (PFV) using Doppler ultrasonography, as well as serum TNFa, vCAM-1, and E-Selectin at 2 and 24 hours after supraselective TACE in 15 consecutive patients with cirrhosis and hepatocellular carcinoma.


RESULTS
Variations in PFV occurred both in the embolized and non-embolized liver lobe. PFV increased significantly at 2 hours in the right and left portal vein. At 24 hours, right PFV remained elevated. Serum TNFa increased significantly at 2 hours, but VCAM-1 and E-Selectin levels remained unchanged. Changes in right and left PFV showed a positive correlation (r=0.9, p<0.001). No correlation could be observed between biological and Doppler changes in portal veins.


CONCLUSIONS
In patients with cirrhosis and hepatocellular carcinoma, PFV increased in both liver lobes 2 hours after supraselective TACE, in association with high serum TNFa. Diffuse changes in PFV after TACE suggests that mechanisms involved in the regulation of portal and hepatic arterial hemodynamics are present in patients with cirrhosis. A major role for TNFa in acute portal flow velocity variations is unlikely in this situation.
Spahr
Laurent
L
Gastroenterology and Hepatology, University Hospital, Geneva, Switzerland. Laurent.Spahr@hcuge.ch
Becker
Christoph
C
Pugin
Jérôme
J
Majno
Pietro E
PE
Hadengue
Antonine
A
D000368:Aged; D000369:Aged, 80 and over; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D001783:Blood Flow Velocity; D001831:Body Temperature / Q000502:physiology; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000628:therapy; D016461:Chemoembolization, Therapeutic; D019040:E-Selectin / Q000097:blood*; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood / Q000503:physiopathology* / Q000628:therapy; D008113:Liver Neoplasms / Q000097:blood / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000628:therapy; D008297:Male; D008875:Middle Aged; D017082:Portal Pressure / Q000502:physiology; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000502:physiology; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism*; D018616:Ultrasonography, Doppler, Duplex; D019010:Vascular Cell Adhesion Molecule-1 / Q000097:blood*
D019040:E-Selectin; D014409:Tumor Necrosis Factor-alpha; D019010:Vascular Cell Adhesion Molecule-1; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase