title: Hepatotoxicity after transarterial chemoembolization and transjugular intrahepatic portosystemic shunt: do two rights make a wrong?
abstract: OBJECTIVE
  To compare the rates of hepatotoxicity after transarterial chemoembolization for hepatocellular carcinoma (HCC) in patients with and without a transjugular intrahepatic portosystemic shunt (TIPS) who were stratified into comparable risk groups.
  
  
  METHODS
  A retrospective review of patients with HCC who were treated with transarterial chemoembolization between January 2005 and December 2009 was performed. Of 158 patients with comparable model for end-stage liver disease (MELD) scores, 10 had a patent TIPS. Hepatobiliary severe adverse events (SAEs) occurring after transarterial chemoembolization were documented. In addition, 1-year survival and liver transplantation rate after transarterial chemoembolization were calculated in each group.
  
  
  RESULTS
  The incidence of hepatobiliary SAEs after transarterial chemoembolization was nearly two times higher in patients with a TIPS (70%) than in patients without a TIPS (36%; P=.046). The liver transplantation rate 1 year after transarterial chemoembolization was 2.5 times higher in patients with a TIPS (80%) than in patients without a TIPS (32%; P=.004). There was no significant difference in 1-year survival between the two groups after transarterial chemoembolization.
  
  
  CONCLUSIONS
  Patients with HCC and a patent TIPS are more likely to develop significant hepatotoxicity after transarterial chemoembolization than comparable patients without a TIPS in place.
authors.affiliation: Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA 94143, USA. maureen.kohi@ucsf.edu
authors.forename: Maureen P
authors.initials: MP
authors.lastname: Kohi
authors.forename: Nicholas
authors.initials: N
authors.lastname: Fidelman
authors.forename: David M
authors.initials: DM
authors.lastname: Naeger
authors.forename: Jeanne M
authors.initials: JM
authors.lastname: LaBerge
authors.forename: Roy L
authors.initials: RL
authors.lastname: Gordon
authors.forename: Robert K
authors.initials: RK
authors.lastname: Kerlan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002140:California / Q000453:epidemiology; D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000628:therapy*; D056486:Chemical and Drug Induced Liver Injury / Q000401:mortality*; D016461:Chemoembolization, Therapeutic / Q000401:mortality*; D003131:Combined Modality Therapy; D015897:Comorbidity; D005260:Female; D006801:Humans; D015994:Incidence; D008113:Liver Neoplasms / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000401:mortality*; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate