Transarterial chemoembolization in patients with elevated bilirubin: predictive value of direct bilirubin as compared to total bilirubin on complications and overall survival.

Final ID:



Original Scientific Research-Oral or Poster 


S Young1, J Gutierrez2, T Chen2, J Golzarian3, T Sanghvi2


1University of Minnesota, Edina, MN, 2University of Minnesota, Minnespolis, MN, 3University of Minnesota, Minneapolis, MN

First Author:

Shamar Young  
University of Minnesota
Edina, MN


Josue Gutierrez  
University of Minnesota
Minnespolis, MN
Ting Chen  
University of Minnesota
Minnespolis, MN
Jafar Golzarian, MD, FSIR  
University of Minnesota
Minneapolis, MN
Tina Sanghvi  
University of Minnesota
Minnespolis, MN

Presenting Author:

Josue Gutierrez  
University of Minnesota
Minnespolis, MN


Transarterial chemoembolization (TACE) has been a mainstay of treatment for non-resectable hepatocellular carcinoma (HCC) for several decades. One of the relative counter indications for TACE has been a bilirubin above 3 mg/dL. However, limited alternative treatment options and adaptation of super selective TACE has led some to investigate the safety of TACE in these patients, with several authors demonstrating good outcomes (1-3). This raises the question of whether or not a more accurate predictor for a patients ability to tolerate TACE could be found. One possible signal which has yet to be investigated is direct versus indirect bilirubin. In cirrhosis, direct or conjugated bilirubin elevates after indirect bilirubin (4). Therefore, patients with an elevated total bilirubin but a relatively normal direct bilirubin may have sufficient hepatic reserve to withstand TACE. The goal of this retrospective review was to determine the predictive value of direct bilirubin as compared to total bilirubin in predicting complications and overall survival.


Between 2010 and 2016, 208 patients underwent TACE at a single academic hospital. The patients charts were reviewed for pre and post treatment lab values, complications, and radiologic response. A multinomial model utilizing Akaike Information Criterion (AIC) was utilized to determine whether direct or total bilirubin better predicted complications at 1 month and overall survival.


Table 1 demonstrates the AIC values for direct and total bilirubin in complications at 1 month, time to progression, and overall survival. Becuasue the AIC numbers are smaller for direct as compared to total bilirubin, we can say that direct bilirubin more accurately predicts these outcomes.


Direct bilirubin more accurately predicts complications at 1 month and overall survival of TACE patients with HCC as compared to total bilirubin. For patients with elevated total bilirubin, a relatively preserved direct bilirubin may indicate an ability to tolerate TACE.

Abstract Categories:

Interventional Oncology: Chemoembolization




AIC Total Bilirubin

AIC Direct Bilirubin




Overall Survival



AIC=Akaike Information Criterion