title: Repeated transcatheter arterial chemoembolization is safe for hepatocellular carcinoma in cirrhotic patients with transjugular intrahepatic portosystemic shunt.
abstract: OBJECTIVE
  We aimed to investigate the safety and long-term outcomes of repeated transcatheter arterial chemoembolization (TACE) in cirrhotic patients with transjugular intrahepatic portosystemic shunt (TIPS).
  
  
  METHODS
  Data of patients with hepatocellular carcinoma, who had previous TIPS implantation and received TACE between January 2010 and December 2012, were reviewed retrospectively. The primary outcome measure was liver function, which was represented by model for end-stage liver disease score, Child-Pugh-Turcotte score, serum total bilirubin, alanine aminotransferase, and aspartate aminotransferase. Changes in liver function before and after the initial TACE procedure and hepatobiliary severe adverse events (SAEs) were compared. Liver function following the initial TACE session was compared with that obtained in later TACE sessions. The secondary outcome measures were tumor response to multiple TACE sessions and survival.
  
  
  RESULTS
  Seventeen patients underwent at least two TACE sessions, while nine patients underwent at least three sessions during the follow-up period. There was no statistically significant difference between the liver function tests performed before and one-month after the TACE procedure. Grade 3 or 4 SAEs occurred in six (31.6 %) patients within one month. The one, two-, and three-year survival rates were 88%, 53%, and 32%, respectively. Tumor response of multiple TACE sessions was the only predictive risk factor of mortality (OR=4.40; P = 0.030; 95% CI, 1.15-16.85).
  
  
  CONCLUSIONS
  Our results suggest that repeated TACE is safe in selected patients with TIPS.
authors.affiliation: Institution of Interventional Radiology, West China Hospital, Sichuan University, Sichuan, China; Department of Gastroenterology, West China Hospital, Sichuan University, Sichuan, China. simonlixiao@126.com.
authors.forename: Zhu
authors.initials: Z
authors.lastname: Wang
authors.forename: Hailong
authors.initials: H
authors.lastname: Zhang
authors.forename: He
authors.initials: H
authors.lastname: Zhao
authors.forename: Xiaoze
authors.initials: X
authors.lastname: Wang
authors.forename: Jiaywei
authors.initials: J
authors.lastname: Tsauo
authors.forename: Xuefeng
authors.initials: X
authors.lastname: Luo
authors.forename: Xiao
authors.initials: X
authors.lastname: Li
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy / Q000473:pathology / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects / Q000379:methods*; D004317:Doxorubicin / Q000008:administration & dosage; D004998:Ethiodized Oil / Q000008:administration & dosage; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D008103:Liver Cirrhosis / Q000473:pathology / Q000503:physiopathology*; D008113:Liver Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000009:adverse effects / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D004998:Ethiodized Oil; D004317:Doxorubicin; D005472:Fluorouracil