title: Liver Function Tests Following Irreversible Electroporation of Liver Tumors: Experience in 174 Procedures.
abstract: Irreversible electroporation (IRE) is a relatively new ablation modality that uses electric currents to cause cell death. It is commonly used to treat primary and secondary liver tumors in patients with normal liver function and preexisting cirrhosis. Retrospective analysis of 205 procedures sought to evaluate changes in liver function after IRE. Liver function tests (LFTs) results before and after IRE were evaluated from 174 procedures in 124 patients. Aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase (ALKP), and total bilirubin levels were analyzed. The study was Health Insurance Portability and Accountability Act compliant and institutional review board approved. Informed consent was waived. Changes in LFT results after IRE were compared with baseline and were followed up over time to see if they resolved. Changes were compared with volume of ablation. The greatest perturbations were in transaminase levels. The levels increased sharply within 24 hours after IRE in 129 (74.1%) procedures to extreme levels (more than 20 times the upper limit of normal in one-third of cases). Resolution occurred in 95% and was demonstrated to have occurred by a mean of approximately 10 weeks, many documented as early as 7 days after procedure. ALKP levels elevated in 10% procedures, was slower to increase, and was less likely to resolve. Total bilirubin level demonstrated 2 different patterns of elevation--early and late--and similar to ALKP, it was more likely to remain elevated. There was no increased risk in patients with cirrhosis or cholangiocarcinoma. There was no correlation of levels with volume of ablation. IRE results in significant abnormalities in LFT results, but in most of the cases, these are self-limiting, do not preclude treatment, and are similar to the changes seen after radiofrequency and cryoablation in the liver.
authors.affiliation: Department of Vascular and Interventional Radiology, Miller School of Medicine, University of Miami, Miami, FL. Electronic address: tfroud@miami.edu.
authors.forename: Tatiana
authors.initials: T
authors.lastname: Froud
authors.affiliation: Department of Vascular and Interventional Radiology, Miller School of Medicine, University of Miami, Miami, FL.
authors.forename: Shree R
authors.initials: SR
authors.lastname: Venkat
authors.affiliation: Department of Vascular and Interventional Radiology, Miller School of Medicine, University of Miami, Miami, FL.
authors.forename: Katuzka J
authors.initials: KJ
authors.lastname: Barbery
authors.affiliation: Department of Vascular and Interventional Radiology, Miller School of Medicine, University of Miami, Miami, FL.
authors.forename: Arora
authors.initials: A
authors.lastname: Gunjan
authors.affiliation: Department of Vascular and Interventional Radiology, Miller School of Medicine, University of Miami, Miami, FL.
authors.forename: Govindarajan
authors.initials: G
authors.lastname: Narayanan
mesh_terms: D055011:Ablation Techniques / Q000009:adverse effects; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000410:Alanine Transaminase / Q000097:blood; D000469:Alkaline Phosphatase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D001663:Bilirubin / Q000097:blood; D015415:Biomarkers / Q000097:blood; D016923:Cell Death; D018274:Electroporation / Q000379:methods*; D005260:Female; D006801:Humans; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000097:blood / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D049268:Positron-Emission Tomography; D011183:Postoperative Complications / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted / Q000009:adverse effects / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D015415:Biomarkers; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D000469:Alkaline Phosphatase; D001663:Bilirubin
keywords: ALKP; ALT; AST; Alanine aminotransaminase; Alkaline phosphatase; Aspartate aminotransaminase; Bilirubin; Cirrhosis; IRE; LFTs; Liver function; TBIL; Tumor; XXX SGOT; XXX SGPT