title: Fatal ischemic acute pancreatitis complicating trans-catheter arterial embolization of small hepatocellular carcinoma: do the risks outweigh the benefits?
abstract: Hepatocellular carcinoma (HCC) is an accepted indication for liver transplantation (LT). Pre-LT adjuvant ablation treatments to prevent tumour progression and drop out from the waiting list have been increasingly adopted at most transplant centers. Trans-catheter arterial chemo-embolization (TACE) is frequently used, but the procedure can be difficult and severe complications may arise. Among them, acute ischemic pancreatitis occasionally occurs and may clinically mimic a post-embolization syndrome. Fatal outcomes of this complication have been reported exceptionally but never in patients awaiting LT. The present case raises concern about the widespread application of TACE and highlights the need for a critical evaluation of the risks and benefits to patients with monofocal small HCC who are scheduled for LT. Superselective embolization of the tumour-feeding artery and systematic monitoring of serum pancreatic enzymes after this radiological procedure are recommended.
authors.affiliation: Hepatology Unit, Department of Gastroenterology, Cardarelli Hospital, Napoli, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Addario
authors.forename: Giovan Giuseppe
authors.initials: GG
authors.lastname: Di Costanzo
authors.forename: Giovanni
authors.initials: G
authors.lastname: Tritto
authors.forename: Enrico
authors.initials: E
authors.lastname: Cavaglià
authors.forename: Basilio
authors.initials: B
authors.lastname: Angrisani
authors.forename: Antonio
authors.initials: A
authors.lastname: Ascione
mesh_terms: D000208:Acute Disease; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology / Q000628:therapy*; D004621:Embolization, Therapeutic / Q000009:adverse effects* / Q000706:statistics & numerical data; D017809:Fatal Outcome; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*; D008113:Liver Neoplasms / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*; D012307:Risk Factors; D014057:Tomography, X-Ray Computed