Liver Function Tests Following Irreversible Electroporation of Liver Tumors: Experience in 174 Procedures.
Irreversible electroporation (IRE) is a relatively new ablation modality that uses electric currents to cause cell death. It is commonly used to treat primary and secondary liver tumors in patients with normal liver function and preexisting cirrhosis. Retrospective analysis of 205 procedures sought to evaluate changes in liver function after IRE. Liver function tests (LFTs) results before and after IRE were evaluated from 174 procedures in 124 patients. Aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase (ALKP), and total bilirubin levels were analyzed. The study was Health Insurance Portability and Accountability Act compliant and institutional review board approved. Informed consent was waived. Changes in LFT results after IRE were compared with baseline and were followed up over time to see if they resolved. Changes were compared with volume of ablation. The greatest perturbations were in transaminase levels. The levels increased sharply within 24 hours after IRE in 129 (74.1%) procedures to extreme levels (more than 20 times the upper limit of normal in one-third of cases). Resolution occurred in 95% and was demonstrated to have occurred by a mean of approximately 10 weeks, many documented as early as 7 days after procedure. ALKP levels elevated in 10% procedures, was slower to increase, and was less likely to resolve. Total bilirubin level demonstrated 2 different patterns of elevation--early and late--and similar to ALKP, it was more likely to remain elevated. There was no increased risk in patients with cirrhosis or cholangiocarcinoma. There was no correlation of levels with volume of ablation. IRE results in significant abnormalities in LFT results, but in most of the cases, these are self-limiting, do not preclude treatment, and are similar to the changes seen after radiofrequency and cryoablation in the liver.
['Froud|Tatiana|T|', 'Venkat|Shree R|SR|', 'Barbery|Katuzka J|KJ|', 'Gunjan|Arora|A|', 'Narayanan|Govindarajan|G|']
D055011:Ablation Techniques D000328:Adult D000368:Aged D000369:Aged, 80 and over D000410:Alanine Transaminase D000469:Alkaline Phosphatase D001219:Aspartate Aminotransferases D001663:Bilirubin D015415:Biomarkers D016923:Cell Death D018274:Electroporation D005260:Female D006801:Humans D008111:Liver Function Tests D008113:Liver Neoplasms D008297:Male D008875:Middle Aged D009929:Organ Size D049268:Positron-Emission Tomography D011183:Postoperative Complications D011237:Predictive Value of Tests D012189:Retrospective Studies D025321:Surgery, Computer-Assisted D013997:Time Factors D016896:Treatment Outcome D055815:Young Adult
Liver function Tumor IRE Cirrhosis LFTs Alkaline phosphatase ALKP Bilirubin ALT AST Alanine aminotransaminase Aspartate aminotransaminase TBIL XXX SGOT XXX SGPT