Worse clinical outcomes of TACE when liver function is decompensated in a cohort of patients with cirrhosis and HCC waiting for liver transplantation

• TACE procedures completed in patients with decompensated liver function were associated with worse clinical outcomes. • Albumin <3g/dL and bilirubin >3 mg/dL were independently associated with poor outcomes within 90 days of a TACE procedure. • Death and delisting were not significantly different between the compensated and decompensated liver function groups. Trans arterial chemoembolization (TACE) is the most frequently utilized locoregional therapy for patients with hepatocellular carcinoma (HCC). The reported evidence has been mixed regarding outcomes in patients with decompensated cirrhosis who undergo TACE. The aim of our study was to evaluate the clinical outcomes of patients with cirrhosis and HCC that underwent TACE procedures while awaiting liver transplantation. This was a retrospective cohort study of patients listed for transplant between February 2018 and April 2022. We analyzed 74 patients that had a total of 171 TACE procedures, and defined outcomes within 90 days of TACE in four categorical levels as follows: clinical stability/improvement (1), worsening of liver functioning (2), hospitalization (3), and death or delisting (4). The primary statistical analysis was based on multinomial modeling of this categorical outcome. Patients with decompensated liver function at the time of TACE had odds of being hospitalized within 90 days of the TACE procedure that were 8 times higher than those with compensated liver function (p=0.007). Patients with albumin <3 g/dL or bilirubin >3mg/dL were more likely to experience poor outcomes within 90 days following TACE. There was no statistically significant difference in death and delisting after TACE between patients with compensated and decompensated liver function, though the sample size in this outcome was small.