title: Liver abscess after transarterial chemoembolization in patients with bilioenteric anastomosis: frequency and risk factors.
abstract: OBJECTIVE
  The purpose of this study was to clarify the frequency of and risk factors for liver abscess formation after transarterial chemoembolization (TACE) in patients with hepatocellular carcinoma or metastatic hepatic tumors after undergoing bilioenteric anastomosis.
  
  
  METHODS
  From January 1996 to June 2012, 25 patients (21 men, four women; age range, 34-74 years) with hepatocellular carcinoma (n = 12) or metastatic hepatic tumors (n = 13) with an underlying bilioenteric anastomosis underwent 65 TACE procedures. The incidence of liver abscess, predisposing factors (diabetes, Child-Pugh class, leukopenia, tumor number, tumor size, tumor burden, tumor type, portal vein thrombus, lipiodol dose, particulate embolization, embolization selectivity, oily portogram, antibiotic prophylaxis, and occurrence of liver abscess at initial TACE), and clinical outcome were evaluated. Statistical analysis for relations between liver abscess and predisposing factors was performed by Fisher exact test and linear-by-linear association.
  
  
  RESULTS
  Liver abscess developed after 17 of 65 (26.2%) TACE procedures performed on 12 of 25 (48%) patients. Two patients died of progression of liver abscess into sepsis. Univariate and multivariate analyses showed that leukopenia (p = 0.029), occurrence of liver abscess at initial TACE (p = 0.082), and particulate embolization or oily portogram (grade 2) (p = 0.001) were associated with a higher incidence of liver abscess.
  
  
  CONCLUSIONS
  The incidence of liver abscess was high among patients with bilioenteric anastomoses who underwent TACE. Leukopenia, occurrence of liver abscess at initial session of TACE, and particulate embolization or oily portogram (grade 2) were associated with the development of liver abscess.
authors.affiliation: Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongnogu, Seoul 110-744, Korea.
authors.forename: Sungmin
authors.initials: S
authors.lastname: Woo
authors.forename: Jin Wook
authors.initials: JW
authors.lastname: Chung
authors.forename: Saebeom
authors.initials: S
authors.lastname: Hur
authors.forename: Seung-Moon
authors.initials: SM
authors.lastname: Joo
authors.forename: Hyo-Cheol
authors.initials: HC
authors.lastname: Kim
authors.forename: Hwan Jun
authors.initials: HJ
authors.lastname: Jae
authors.forename: Jae Hyung
authors.initials: JH
authors.lastname: Park
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods*; D006528:Carcinoma, Hepatocellular / Q000601:surgery / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects*; D003287:Contrast Media; D005260:Female; D006801:Humans; D007472:Iohexol / Q000031:analogs & derivatives; D007479:Iopamidol; D008100:Liver Abscess / Q000209:etiology*; D008113:Liver Neoplasms / Q000601:surgery / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D007472:Iohexol; C038192:iopromide; D007479:Iopamidol