Indocyanine Green as a Predictor of Development of Post Transarterial Chemoembolisation Liver Failure

Abstract

Background and Aim: Post-TACE liver failure occurs in upto 60% of hepatocellular carcinoma patients. The presence of ascites, advanced Child-Turcotte-Pugh score and gastrointestinal bleeding are associated with an increased risk. No objective parameter predicts the risk. In a prospective study, we assessed the role of indocyanine green (ICG) in predicting post TACE liver failure. Methods: ICG test was done on the day of the TACE. ICG-plasma disappearance rate (ICG-PDR) and R-15 were recorded and assessed as predictors of development of liver failure post procedure. Results: A total of 31 patients were included. The mean age ± SD was 53.5 ± 13.9 years. Among these 25 (81%) were males and 6 (19%) were females. The etiologies were hepatitis B in 19 (61.2%), hepatitis C in 6 (19.3), alcohol in 2 (6.4%) and NASH in 3 (9.6%). One patient had a dual hepatitis B and hepatitis C infection. Sixteen patients (51.6%) had Child A and rest 15 (48.4%) had Child B status. Post-TACE syndrome developed in 26 (84%) and post TACE liver failure in 11 (35.5%), all these patients had underlying Child B status. The median value of PDR in patients developing liver failure was 7.4%/min (range 2–15) versus 11.8%/min (5–27) in those who did not develop liver failure (P < 0.008). The median R15 value in patients developing liver failure was 33% (10.5%–73%) vs 17% (1.7%–50.9%) in those who did not develop liver failure. The area under the curve for R15 as a predictor of liver failure was 0.78. A cut off value of 24.15% predicts the development of liver failure with a sensitivity of 72.7% and specificity of 70%. None of the patients died after the procedure. Conclusions: ICG is a useful predictor of development of liver failure in patients undergoing TACE. It can be used as a better objective parameter in stratifying patients within the same child class who are at risk of developing post TACE liver failure.