Deterioration in liver function after liver‐directed therapy for hepatocellular carcinoma measured by cholate clearance. Issue 5 (3rd September 2020)

• Record Type: Journal Article
• Authors: Hoteit, Maarouf A.; Wojcieszynski, Andrezj; Currie, Brian; Levine, Matthew H.; Forde, Kimberly A.; Reiss, Kim A.; Nadolski, Greg; Soulen, Michael C.; Helmke, Steve; Everson, Gregory T.; Ben‐Josef, Edgar
• Is Part Of: GastroHep. Volume 2:Issue 5(2020)
• Page Start: 232
• Page End: 239
• Publication Date: 2020-09-03
• Subjects: Gastroenterology -- Periodicals; Hepatology -- Periodicals; 616.33
• DOI: 10.1002/ygh2.421
• Languages: English
• ISSNs: 2689-3711

Abstract

Summary: Background: Liver‐directed therapy (LDT) for hepatocellular carcinoma (HCC) carries a risk of serious liver toxicity, but the risk is not accurately predicted. Our aim is to evaluate the baseline and change in liver function after LDT measured by a potentially more sensitive test than the usual clinical assessment. Methods: We conducted a prospective cohort study of patients undergoing LDT for HCC. We evaluated cholate clearance at baseline (T0) and 4‐10 weeks after (T1) LDT in 11 patients. Hepatotoxicity was defined as the development of a new complication of cirrhosis or an increase in Child score by ≥2 points. Results: Four patients (36.4%) were Child A and the remainder (63.6%) Child B. Patients were BCLC stage A (63.6%) or BCLC stage B (36.4%). LDT modalities were Transarterial Chemoembolisation (TACE) (45.5%) or external beam radiotherapy (EBRT) (54.5%). From T0 to T1, there was a reduction in oral cholate clearance (4.29 [2.43‐15.89] mL/kg/min to 3.58 [2.21‐15.68] mL/kg/min, P = 0.05) and a trend towards a worsening Disease Severity Index (32.01 [17.11‐39.07] vs 33.01 [18.64‐40.20], P = 0.06); however, there was no significant change in MELD (12 [9‐13] vs 11 [10‐12], P = 0.72), or Child score (7 [5‐8] vs 7 [6‐8], P = 0.15). Hepatotoxicity was observed in 42.9% Child B patients and none of the Child A patients; and in 60.0% patients with a baseline DSI > 35, and none of the patients with DSI < 35. Conclusions: The dual cholate clearance assay may better define baseline disease severity and may be more sensitive to change in liver function induced by LDT than traditional measures.