To investigate clinical characteristics, risk factors and prognosis of liver abscess after TACE.

Clinical data of 857 patients with liver tumors admitted to Affiliated Hospital of Jiangnan University from November 2020 to March 2022 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 518 patients were male and 339 female, aged from 38 to 80 years, with a median age of 61 years. The incidence, clinical characteristics, risk factors and prognosis of liver abscess after TACE were analyzed.

1 164 TACE were performed in 857 patients, and 7 cases developed liver abscess, including 5 cases of air-fluid level liver abscess. The incidence of liver abscess was 0.60%(7/1 164), and the mortality rate of liver abscess was 2/7. Among 7 patients, 5 were male and 2 female, aged (70±9) years on average. 4 cases were complicated with HBV infection and 2 cases of type 2 diabetes mellitus. 3 patients were diagnosed with hepatocellular carcinoma, 1 case of primary hepatic neuroendocrine carcinoma and 3 cases of metastatic liver cancer. The tumor diameter was (8.6±2.1) cm. The number of TACE was 4±2 for each patient. The dosage of iodized oil was (12±5) ml. Drug-loaded microspheres were utilized in 5 patients and gelatin sponge in 2 cases. Liver abscess occurred at postoperative 3-20 d, with a median time of 7 d. The treatment time was 8-28 d, with a median time of 16 d. The initial symptoms of patients with liver abscess mainly included fever and abdominal pain. All 7 cases were complicated with systemic inflammatory response syndrome and treated with antibiotics. Puncture and drainage were performed in 5 cases. 6 cases were complicated with bilateral pleural effusion and 1 case of right pleural effusion, and 3 among them were treated with right pleural puncture and drainage. The positive rate of pus sample was 1/8. Other culture tests showed 6 cases of Gram-negative bacilli, including 1 case of anaerobic Enterobacter aerogenes. Compared with before TACE, the inflammatory indexes of patients with liver abscess were increased significantly after the diagnosis of liver abscess, and the main manifestations of liver function injury was the decline of liver synthesis and metabolism.

The incidence of liver abscess after TACE is relatively low. Air-fluid level can be observed in a majority of liver abscesses. Most of the bacteria are Gram-negative bacilli. Liver abscess poses severe injury to the liver. Antibiotics and puncture and drainage are the main treatment strategies. The incidence of liver abscess may be associated with patients’age, number of tumor embolization, the size of abscess and diabetes mellitus, etc. Intimate follow-up, early diagnosis and treatment should be performed in these patients.