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 with 90Y in patients with liver
malignancy and a history of biliary intervention.