Role of N-acetyl cysteine in post TACE transaminitis in hepatocellular carcinoma – A single center experience

Abstract Background and aim Transarterial chemoembolization (TACE) is the most common locoregional therapy for hepatocellular carcinoma (HCC). Post embolization syndrome is not an uncommon complication. At present there is no specific treatment for management of this complication. We aimed to study the role of N-acetyl cysteine (NAC) an anti-oxidant in management of this complication. Methods In a prospective observational study, consecutive patients with HCC, undergoing TACE from January 2016 to January 2017 were included. Patients with post embolization syndrome, defined as an elevation of transaminases more than 3 - 4 times upper limit of normal were administered intravenous NAC for 72 hours (150 mg/kg for 1 hour, then 12.5 mg/kg/h for 4 hours, and continuous infusion 6.25 mg/h for remaining 67 hours). The other group received only supportive standard of care. Primary endpoint was reduction in post TACE transaminitis. Results Out of 112 patients with HCC 53 (47.3%) received NAC. Majority were cirrhotics in both the groups. Both groups were well matched in demographic, laboratory and tumour characteristics. In the NAC group, there was significant reduction of AST and ALT levels from day 1 to day 3 (p - 0.000) compared to non-NAC group with no significant change in bilirubin or INR. The duration of hospital stay was similar in both groups. None had any major adverse events to NAC. Conclusions This is a prospective, single centre experience, showing that early initiation of N-acetyl cysteine in those with post TACE embolization syndrome, reduces the transaminases significantly.