Transarterial embolization for hepatocellular carcinoma. Antibiotic prophylaxis and clinical meaning of postembolization fever

Background/Aims: The aim of this prospective randomized controlled trial was to investigate the need for prophylactic antibiotherapy in patients with cirrhosis and hepatocellular carcinoma who underwent transarterial embolization and to establish the parameters that determine the development of fever>38°C after this procedure. Methods: Sixty-one consecutive patients with cirrhosis undergoing 75 procedures were randomized into Group I [(n=37) allocated to receive prophylactic antibiotics (Cefotaxime+Metronidazole)] and Group II [(n=38) allocated to receive no antibiotic treatment]. Results: Twelve of the 37 patients (32%) in Group I and 13 of the 38 patients (34%) in Group II developed fever>38°C after treatment. However, none of them developed bacterial infection, and all biological fluid cultures were negative. A logistic regression analysis disclosed that the obtention of an extensive tumor necrosis was the unique parameter independently associated with the development of fever. Conclusion: Antibiotic prophylaxis is therefore not necessary in patients with cirrhosis and hepatocellular carcinoma undergoing transarterial embolization. The appearance of fever after this procedure does not indicate bacterial infection; it rather represents a clinical marker of extensive tumor necrosis and thus of a favorable response to treatment