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

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Abstract

Background

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.

Aim

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

Methods

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.

Results

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.

Conclusions

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).

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Abbreviations

TACE:

Transarterial chemoembolization

HCC:

Hepatocellular carcinoma

NAC:

N-acetylcysteine

BCLC:

Barcelona clinic liver center

HBV:

Hepatitis B virus

HCV:

Hepatitis C virus

MELD:

Model for end-stage liver disease

PV:

Portal vein

AST:

Aspatate aminotransferase

ALT:

Alanine aminotransferase

5-FU:

5-Fluorouracil

WBC:

White blood cell

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Acknowledgments

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

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Authors and Affiliations

  1. Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand

    Sith Siramolpiwat, Thanachai Punjachaipornpon, Bubpha Pornthisarn, Ratha-korn Vilaichone, Soonthorn Chonprasertsuk, Anupong Tangaroonsanti & Patommatat Bhanthumkomol

  2. Chulabhorn International College of Medicine, Thammasat University, Pathum Thani, Thailand

    Sith Siramolpiwat, Ratha-korn Vilaichone, Achara Phumyen, Atipat Yasiri & Mayurachat Kaewmanee

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  1. Sith Siramolpiwat
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  2. Thanachai Punjachaipornpon
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Correspondence to Sith Siramolpiwat.

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Siramolpiwat, S., Punjachaipornpon, T., Pornthisarn, B. et al. N-Acetylcysteine Prevents Post-embolization Syndrome in Patients with Hepatocellular Carcinoma Following Transarterial Chemoembolization. Dig Dis Sci 64, 3337–3345 (2019). https://doi.org/10.1007/s10620-019-05652-0

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