Safety and feasibility of same-day discharge of patients with hepatocellular carcinoma treated with transarterial chemoembolization with drug-eluting beads in a liver transplantation program.
OBJECTIVE
To evaluate the safety and feasibility of same-day discharge of patients with hepatocellular carcinoma (HCC) treated with transarterial chemoembolization with the use of drug-eluting beads (DEBs) and elucidate the prognostic factors for hospital admission.


METHODS
A total of 266 DEB chemoembolization procedures in 154 consecutive patients listed for liver transplantation or identified for potential HCC downstaging were performed with the outpatient treatment protocol. Endpoints evaluated were admission to the hospital after the procedure for clinical reasons, readmission to the hospital within 1 month of the procedure, and procedure-related morbidity and mortality. In the evaluation of prognostic factors for admission, parameters of patients discharged the same day were compared with those of patients admitted overnight.


RESULTS
Same-day discharge was feasible in 238 cases (89.5%), and 28 (10.5%) needed overnight admission. The main reason for overnight admission was postprocedural abdominal pain (n = 23; 67.8%). The procedure-related complication rate was 2.6%, and there were no readmissions or deaths during the first 30 days after chemoembolization. Chemoembolization performed for downstaging and the use of more than one vial of embolic agent were associated with an increased need for overnight admission (P = .012 and P = .007, respectively).


CONCLUSIONS
Same-day discharge of patients with HCC treated with DEB chemoembolization in a liver transplantation program is safe and feasible, with low complication and admission rates. Treatment for HCC downstaging and the use of more than one vial of embolic agent were associated with an increased need for hospital admission.
Department of Interventional Radiology, São Paulo SP 05652-900, Brazil.
Felipe
F
Nasser
Department of Interventional Radiology, São Paulo SP 05652-900, Brazil. Electronic address: rafaelnoronha@yahoo.com.br.
Rafael N
RN
Cavalcante
Department of Interventional Radiology, São Paulo SP 05652-900, Brazil.
Francisco L
FL
Galastri
Liver Transplantation, Hospital Israelita Albert Einstein, 627 Albert Einstein St., São Paulo SP 05652-900, Brazil.
Marcelo B
MB
de Rezende
Liver Transplantation, Hospital Israelita Albert Einstein, 627 Albert Einstein St., São Paulo SP 05652-900, Brazil.
Guilherme G
GG
Felga
Department of Interventional Radiology, São Paulo SP 05652-900, Brazil.
Fabiellen B
FB
Travassos
Department of Interventional Radiology, São Paulo SP 05652-900, Brazil.
Bruna
B
De Fina
Department of Interventional Radiology, São Paulo SP 05652-900, Brazil.
Breno B
BB
Affonso
D015746:Abdominal Pain / Q000209:etiology; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D016009:Chi-Square Distribution; D004337:Drug Carriers; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007902:Length of Stay; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016031:Liver Transplantation; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy / Q000009:adverse effects / Q000401:mortality; D009367:Neoplasm Staging; D016017:Odds Ratio; D010343:Patient Admission; D010351:Patient Discharge; D015397:Program Evaluation; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
D000970:Antineoplastic Agents; D004337:Drug Carriers