Abstract
Purpose Yttrium 90 (Y90) transarterial radioembolization (TARE) is effective for unresectable
hepatocellular carcinoma (HCC) or to bridge/downstage before transplant; however,
optimal patient selection is not well-described. This study aims to identify factors
that increase risk of liver decompensation resulting in hospital admissions after
TARE.
Methods Patients who received Y90 as their first treatment during 2012 to 2022 were identified
from a prospectively collected database of 1675 HCC patients. Clinically significant
hepatic decompensation was defined as total bilirubin more than or equal to 3 mg/dL
or any increase in Model for End-stage Liver Disease (MELD) score resulting in readmission
within 60 days or death.
Results Of 137 patients, 7 (5.1%) developed hepatic decompensation requiring admission within
30 days and an additional 8 (10.9%) within 60 days. Two of these patients (1.4%) died
and two (1.4%) required urgent transplant within 2 months. Preprocedure albumin less
than 3.5 gm/dL (p = 0.0207), international normalized ratio more than 1.2 (p = 0.017), ascites (p = 0.036), elevated MELD (p = 0.012), and Child-Pugh (p = 0.007) scores were significant predictors of decompensation, while creatinine and
sodium were not. Patients with Child-Pugh B score were three to four times more likely
to decompensate (28 vs. 8%) compared to Child-Pugh A. For every unit increase in Child-Pugh
score more than 6, odds of decompensation increased by a factor of 2.15.
Conclusion Y90 TARE is safe and effective; however, 10.9% patients require readmission for worsened
liver function. Because ascites is a significant factor in predicting decompensation
and all patients require adequate renal function to receive Y90 TARE, Child-Pugh score
may be more useful than MELD for patient selection. Further risk stratification may
be required for those with a Child-Pugh score more than or equal to 7.
Keywords
hepatocellular carcinoma - yttrium 90 - transarterial radioembolization
