TRANSARTERIAL EMBOLIZATION FOR HEPATOCELLULAR-CARCINOMA - ANTIBIOTIC-PROPHYLAXIS AND CLINICAL MEANING OF POSTEMBOLIZATION FEVER

Background/Aims: The aim of this prospective randomized controlled tri al was to investigate the need for prophylactic antibiotherapy in pati ents with cirrhosis and hepatocellular carcinoma who underwent transar terial embolization and to establish the parameters that determine the development of fever >38 degrees C after this procedure. Methods: Six ty-one consecutive patients with cirrhosis undergoing 75 procedures we re randomized into Group I [(n=37) allocated to receive prophylactic a ntibiotics (Cefotaxime+Metronidazole)] and Group II [(n=38) allocated to receive no antibiotic treatment]. Results: Twelve of the 37 patient s (32%) in Group I and 13 of the 38 patients (34%) in Group II develop ed fever >38 degrees C after treatment. However, none of them develope d bacterial infection, and all biological fluid cultures were negative . A logistic regression analysis disclosed that the obtention of an ex tensive tumor necrosis was the unique parameter independently associat ed with the development of fever. Conclusions: Antibiotic prophylaxis is therefore not necessary in patients with cirrhosis and hepatocellul ar carcinoma undergoing transarterial embolization. The appearance of fever after this procedure does not indicate bacterial infection; it r ather represents a clinical marker of extensive tumor necrosis and thu s of a favorable response to treatment.