90Y Radioembolization for hepatic malignancy in patients with previous biliary intervention: Multicenter analysis of hepatobiliary infections

Kavi K. Devulapalli, Nicholas Fidelman, Michael C. Soulen, Matthew Miller, Matthew S. Johnson, Eric Addo, Ghassan El-Haddad, Charles Nutting, James Morrison, Khashayar Farsad, R. Peter Lokken, Ron C. Gaba, Jacob Fleming, Daniel B. Brown, Sharon W. Kwan, Steven C. Rose, Kevin A. Pennycooke, David M. Liu, Sarah B. White, Ripal Gandhi & 2 others Ann A. Lazar, Robert K. Kerlan

Research output: Contribution to journalArticle

Abstract

Purpose: To determine the frequency of hepatobiliary infections after transarterial radioembolization (TARE) with yttrium 90 (90Y) in patients with liver malignancy and a history of biliary intervention. Materials and Methods: For this retrospective study, records of all consecutive patients with liver malignancy and history of biliary intervention treated with TARE at 14 centers between 2005 and 2015 were reviewed. Data regarding liver function,90Y dosimetry, antibiotic prophylaxis, and bowel preparation prophylaxis were collected. Primary outcome was development of hepatobiliary infection. Results: One hundred twenty-six patients (84 men, 42 women; mean age, 68.8 years) with primary (n = 39) or metastatic (n = 87) liver malignancy and history of biliary intervention underwent 180 procedures with glass (92 procedures) or resin (88 procedures) microspheres. Hepatobiliary infections (liver abscesses in nine patients, cholangitis in five patients) developed in 10 of the 126 patients (7.9%) after 11 of the 180 procedures (6.1%; nine of those procedures were performed with glass microspheres). All patients required hospitalization (median stay, 12 days; range, 2-113 days). Ten patients required percutaneous abscess drainage, three patients underwent endoscopic stent placement and stone removal, and one patient needed insertion of percutaneous biliary drains. Infections resolved in five patients, four patients died (two from infection and two from cancer progression while infection was being treated), and one patient continued to receive suppressive antibiotics. Use of glass microspheres (P = .02), previous liver resection or ablation (P = .02), and younger age (P = .003) were independently predictive of higher infection risk. Conclusion: Infectious complications such as liver abscess and cholangitis are uncommon but serious complications of transarterial radioembolization with90Y in patients with liver malignancy and a history of biliary intervention.

LanguageEnglish (US)
Pages774-781
Number of pages8
JournalRADIOLOGY
Volume288
Issue number3
DOIs
StatePublished - Sep 1 2018

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Liver
Infection
Neoplasms
Microspheres
Glass
Liver Abscess
Cholangitis
Yttrium
Antibiotic Prophylaxis
Abscess
Stents
Drainage
Hospitalization
Retrospective Studies
Anti-Bacterial Agents

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Devulapalli, K. K., Fidelman, N., Soulen, M. C., Miller, M., Johnson, M. S., Addo, E., ... Kerlan, R. K. (2018). 90Y Radioembolization for hepatic malignancy in patients with previous biliary intervention: Multicenter analysis of hepatobiliary infections. RADIOLOGY, 288(3), 774-781. https://doi.org/10.1148/radiol.2018170962

90Y Radioembolization for hepatic malignancy in patients with previous biliary intervention : Multicenter analysis of hepatobiliary infections. / Devulapalli, Kavi K.; Fidelman, Nicholas; Soulen, Michael C.; Miller, Matthew; Johnson, Matthew S.; Addo, Eric; El-Haddad, Ghassan; Nutting, Charles; Morrison, James; Farsad, Khashayar; Peter Lokken, R.; Gaba, Ron C.; Fleming, Jacob; Brown, Daniel B.; Kwan, Sharon W.; Rose, Steven C.; Pennycooke, Kevin A.; Liu, David M.; White, Sarah B.; Gandhi, Ripal; Lazar, Ann A.; Kerlan, Robert K.

In: RADIOLOGY, Vol. 288, No. 3, 01.09.2018, p. 774-781.

Research output: Contribution to journalArticle

Devulapalli, KK, Fidelman, N, Soulen, MC, Miller, M, Johnson, MS, Addo, E, El-Haddad, G, Nutting, C, Morrison, J, Farsad, K, Peter Lokken, R, Gaba, RC, Fleming, J, Brown, DB, Kwan, SW, Rose, SC, Pennycooke, KA, Liu, DM, White, SB, Gandhi, R, Lazar, AA & Kerlan, RK 2018, '90Y Radioembolization for hepatic malignancy in patients with previous biliary intervention: Multicenter analysis of hepatobiliary infections' RADIOLOGY, vol. 288, no. 3, pp. 774-781. https://doi.org/10.1148/radiol.2018170962
Devulapalli, Kavi K. ; Fidelman, Nicholas ; Soulen, Michael C. ; Miller, Matthew ; Johnson, Matthew S. ; Addo, Eric ; El-Haddad, Ghassan ; Nutting, Charles ; Morrison, James ; Farsad, Khashayar ; Peter Lokken, R. ; Gaba, Ron C. ; Fleming, Jacob ; Brown, Daniel B. ; Kwan, Sharon W. ; Rose, Steven C. ; Pennycooke, Kevin A. ; Liu, David M. ; White, Sarah B. ; Gandhi, Ripal ; Lazar, Ann A. ; Kerlan, Robert K. / 90Y Radioembolization for hepatic malignancy in patients with previous biliary intervention : Multicenter analysis of hepatobiliary infections. In: RADIOLOGY. 2018 ; Vol. 288, No. 3. pp. 774-781.
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abstract = "Purpose: To determine the frequency of hepatobiliary infections after transarterial radioembolization (TARE) with yttrium 90 (90Y) in patients with liver malignancy and a history of biliary intervention. Materials and Methods: For this retrospective study, records of all consecutive patients with liver malignancy and history of biliary intervention treated with TARE at 14 centers between 2005 and 2015 were reviewed. Data regarding liver function,90Y dosimetry, antibiotic prophylaxis, and bowel preparation prophylaxis were collected. Primary outcome was development of hepatobiliary infection. Results: One hundred twenty-six patients (84 men, 42 women; mean age, 68.8 years) with primary (n = 39) or metastatic (n = 87) liver malignancy and history of biliary intervention underwent 180 procedures with glass (92 procedures) or resin (88 procedures) microspheres. Hepatobiliary infections (liver abscesses in nine patients, cholangitis in five patients) developed in 10 of the 126 patients (7.9{\%}) after 11 of the 180 procedures (6.1{\%}; nine of those procedures were performed with glass microspheres). All patients required hospitalization (median stay, 12 days; range, 2-113 days). Ten patients required percutaneous abscess drainage, three patients underwent endoscopic stent placement and stone removal, and one patient needed insertion of percutaneous biliary drains. Infections resolved in five patients, four patients died (two from infection and two from cancer progression while infection was being treated), and one patient continued to receive suppressive antibiotics. Use of glass microspheres (P = .02), previous liver resection or ablation (P = .02), and younger age (P = .003) were independently predictive of higher infection risk. Conclusion: Infectious complications such as liver abscess and cholangitis are uncommon but serious complications of transarterial radioembolization with90Y in patients with liver malignancy and a history of biliary intervention.",
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T1 - 90Y Radioembolization for hepatic malignancy in patients with previous biliary intervention

T2 - Radiology

AU - Devulapalli, Kavi K.

AU - Fidelman, Nicholas

AU - Soulen, Michael C.

AU - Miller, Matthew

AU - Johnson, Matthew S.

AU - Addo, Eric

AU - El-Haddad, Ghassan

AU - Nutting, Charles

AU - Morrison, James

AU - Farsad, Khashayar

AU - Peter Lokken, R.

AU - Gaba, Ron C.

AU - Fleming, Jacob

AU - Brown, Daniel B.

AU - Kwan, Sharon W.

AU - Rose, Steven C.

AU - Pennycooke, Kevin A.

AU - Liu, David M.

AU - White, Sarah B.

AU - Gandhi, Ripal

AU - Lazar, Ann A.

AU - Kerlan, Robert K.

PY - 2018/9/1

Y1 - 2018/9/1

N2 - Purpose: To determine the frequency of hepatobiliary infections after transarterial radioembolization (TARE) with yttrium 90 (90Y) in patients with liver malignancy and a history of biliary intervention. Materials and Methods: For this retrospective study, records of all consecutive patients with liver malignancy and history of biliary intervention treated with TARE at 14 centers between 2005 and 2015 were reviewed. Data regarding liver function,90Y dosimetry, antibiotic prophylaxis, and bowel preparation prophylaxis were collected. Primary outcome was development of hepatobiliary infection. Results: One hundred twenty-six patients (84 men, 42 women; mean age, 68.8 years) with primary (n = 39) or metastatic (n = 87) liver malignancy and history of biliary intervention underwent 180 procedures with glass (92 procedures) or resin (88 procedures) microspheres. Hepatobiliary infections (liver abscesses in nine patients, cholangitis in five patients) developed in 10 of the 126 patients (7.9%) after 11 of the 180 procedures (6.1%; nine of those procedures were performed with glass microspheres). All patients required hospitalization (median stay, 12 days; range, 2-113 days). Ten patients required percutaneous abscess drainage, three patients underwent endoscopic stent placement and stone removal, and one patient needed insertion of percutaneous biliary drains. Infections resolved in five patients, four patients died (two from infection and two from cancer progression while infection was being treated), and one patient continued to receive suppressive antibiotics. Use of glass microspheres (P = .02), previous liver resection or ablation (P = .02), and younger age (P = .003) were independently predictive of higher infection risk. Conclusion: Infectious complications such as liver abscess and cholangitis are uncommon but serious complications of transarterial radioembolization with90Y in patients with liver malignancy and a history of biliary intervention.

AB - Purpose: To determine the frequency of hepatobiliary infections after transarterial radioembolization (TARE) with yttrium 90 (90Y) in patients with liver malignancy and a history of biliary intervention. Materials and Methods: For this retrospective study, records of all consecutive patients with liver malignancy and history of biliary intervention treated with TARE at 14 centers between 2005 and 2015 were reviewed. Data regarding liver function,90Y dosimetry, antibiotic prophylaxis, and bowel preparation prophylaxis were collected. Primary outcome was development of hepatobiliary infection. Results: One hundred twenty-six patients (84 men, 42 women; mean age, 68.8 years) with primary (n = 39) or metastatic (n = 87) liver malignancy and history of biliary intervention underwent 180 procedures with glass (92 procedures) or resin (88 procedures) microspheres. Hepatobiliary infections (liver abscesses in nine patients, cholangitis in five patients) developed in 10 of the 126 patients (7.9%) after 11 of the 180 procedures (6.1%; nine of those procedures were performed with glass microspheres). All patients required hospitalization (median stay, 12 days; range, 2-113 days). Ten patients required percutaneous abscess drainage, three patients underwent endoscopic stent placement and stone removal, and one patient needed insertion of percutaneous biliary drains. Infections resolved in five patients, four patients died (two from infection and two from cancer progression while infection was being treated), and one patient continued to receive suppressive antibiotics. Use of glass microspheres (P = .02), previous liver resection or ablation (P = .02), and younger age (P = .003) were independently predictive of higher infection risk. Conclusion: Infectious complications such as liver abscess and cholangitis are uncommon but serious complications of transarterial radioembolization with90Y in patients with liver malignancy and a history of biliary intervention.

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DO - 10.1148/radiol.2018170962

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