N-Acetylcysteine Prevents Post-embolization Syndrome in Patients with Hepatocellular Carcinoma Following Transarterial Chemoembolization

  • Sith SiramolpiwatEmail author
  • Thanachai Punjachaipornpon
  • Bubpha Pornthisarn
  • Ratha-korn Vilaichone
  • Soonthorn Chonprasertsuk
  • Anupong Tangaroonsanti
  • Patommatat Bhanthumkomol
  • Achara Phumyen
  • Atipat Yasiri
  • Mayurachat Kaewmanee
Original Article



Post-embolization syndrome is a common complication after transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). N-acetylcysteine (NAC) is known to ameliorate liver damage from several causes.


To determine the efficacy of intravenous NAC in the prevention of post-embolization syndrome in HCC patients following TACE.


In this study, patients with HCC admitted for TACE were prospectively enrolled. All patients were randomized stratified by Child A or B to receive NAC or placebo. The NAC group received intravenous NAC 24 h prior to TACE (150 mg/kg/h for 1 h followed by 12.5 mg/kg/h for 4 h, then continuous infusion 6.25 mg/h for 48 h after the procedure). The placebo group received an infusion of 5% glucose solution until 48 h after procedure. The post-embolization syndrome was defined as: T ≥ 38.5 c and serum ALT > 3 times of pretreatment value.


In total, 111 HCC patients were enrolled; 57 were randomly assigned to NAC group and 54 to placebo group. The incidence of post-embolization syndrome was lower in NAC group (24.6%) compared to placebo group (48.2%); P = 0.01. On multivariate analysis, receiving IV NAC (P = 0.03) and HCC diameter (P < 0.01) were associated with developing post-embolization syndrome. Post-TACE liver decompensation was documented in 26/111 (23.4%) patients. There was no difference in the incidence of post-TACE liver decompensation between NAC and placebo group.


In this study, intravenous NAC administration reduces the incidence of post-embolization syndrome after TACE in patients with HCC. However, it does not prevent post-TACE liver decompensation.

Trial Registration Number

This study was registered with Thai Clinical Trial Registry (TCTR20150313002).


Hepatocellular carcinoma N-acetylcysteine Post-embolization syndrome Liver cancer 



Transarterial chemoembolization


Hepatocellular carcinoma




Barcelona clinic liver center


Hepatitis B virus


Hepatitis C virus


Model for end-stage liver disease


Portal vein


Aspatate aminotransferase


Alanine aminotransferase




White blood cell



This work was funded by Faculty of Medicine and Chulabhorn International College of Medicine, Thammasat University, Thailand, and Gastrointestinal Association of Thailand.

Compliance with ethical standards

Conflict of interest

All authors declare no conflict of interest.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Sith Siramolpiwat
    • 1
    • 2
    Email author
  • Thanachai Punjachaipornpon
    • 1
  • Bubpha Pornthisarn
    • 1
  • Ratha-korn Vilaichone
    • 1
    • 2
  • Soonthorn Chonprasertsuk
    • 1
  • Anupong Tangaroonsanti
    • 1
  • Patommatat Bhanthumkomol
    • 1
  • Achara Phumyen
    • 2
  • Atipat Yasiri
    • 2
  • Mayurachat Kaewmanee
    • 2
  1. 1.Division of Gastroenterology, Department of Internal Medicine, Faculty of MedicineThammasat UniversityPathum ThaniThailand
  2. 2.Chulabhorn International College of MedicineThammasat UniversityPathum ThaniThailand

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