Reply to Respond: Hepatotoxicity after transarterial chemoembolization and transjugular intrahepatic portosystemic shunt: Do two rights make a wrong

摘要

We appreciate Gaba and colleagues' interest in our recent report (1), and we thank the Editor for allowing us the opportunity to respond. It is clear that the authors have reviewed our article in great depth, and we welcome their comments.In their letter, the authors present their experience with transarterial chemoembolization in seven patients with hepatocellular carcinoma (HCC) and a transjugular intrahepatic portosystemic shunt (TIPS). The authors reported a lower incidence of hepatotoxicity following chemoembolization than was demonstrated in our study (1). However, in their series, all patients but one had Barcelona Clinic Liver Cancer (BCLC) stage A disease, whereas 40% of our patients with a TIPS had BCLC stage B or worse disease. In addition, two of our patients had Child-Pugh class C disease, whereas all those described by Gaba et al had Child-Pugh class A/B cirrhosis. The differences in Child-Pugh class and BCLC staging may explain the increased rate of hepatotoxicity seen in our population compared with a "healthier" cohort with earlier-stage disease. As Gaba et al indicate, the endpoint of transarterial chemoembolization was different between our two studies.