C0557 - Microwave Failure

Amber Cloud, MD, MS¹, Aaron Brenner, MD¹, Kyle Fischer, MD², Steven I. Shedlofsky, MD^1
1University of Kentucky College of Medicine, Lexington, KY; ²University of Kentucky College of Medcine, Lexington, KY

Introduction: Microwave ablation (MWA) is a nonsurgical option for patients with hepatocellular carcinoma but is not without risk. In the following patient, MWA was used to treat hepatocellular carcinoma (HCC) secondary to hepatitis C and led to acute liver failure.

Case Description/Methods: A 60-year-old Caucasian female with cirrhosis secondary to chronic untreated hepatitis C and was found to have HCC with a 3cm mass in segment V, a 2.4 cm nodule in segment IVa on MRI. The patient’s cirrhosis was well compensated with no evidence of portal hypertension, ascites, coagulopathy, encephalopathy, or gastrointestinal bleeds and her MELD score was 8. She underwent four rounds of transarterial chemoembolization for her HCC with still viable residual tumor and was recommended to have CT guided microwave ablation (MWA).

Two days following her MWA the patient was found unresponsive. She was intubated and required the initiation of pressors due to persistent hypotension. On arrival and was found to have a WBC of 23.5, lactate 5.9, Cr 3.31, AST 5050, ALT 5681, ALK Phos 1489, total bilirubin 11.2, INR 8.7, calculated MELD of 47. A liver duplex demonstrated no evidence of thrombosis, and a full infectious workup was negative along with Tylenol and aspirin levels. She developed anuric renal failure and her condition continued to deteriorate until she passed away.

Discussion: Features of acute liver failure include liver enzymes elevated greater than 10 times the upper limit of normal, increased INR, and hepatic encephalopathy, which were all present in this patient. Differential diagnosis for acute liver failure must always include viral, autoimmune, metabolic, vascular and drug induced etiologies. MWA has well documented adverse effects including hemorrhage, thrombosis, and biliary tract manipulation, but acute liver failure without evidence of these findings is rarely found in literature. Alone, any of these adverse effects can cause liver failure, but as evidenced in this patient MWA itself is also a risk factor for acute liver failure. When presented with a patient who is actively undergoing MWA and has acute liver failure, one must consider MWA as an etiology in their differential diagnosis along with ruling out other common causes.



Disclosures:


Amber Cloud, MD, MS¹, Aaron Brenner, MD¹, Kyle Fischer, MD², Steven I. Shedlofsky, MD¹. C0557 - Microwave Failure, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.