Abstract: SA-PO965
Elevated WBC Count in the Peritoneal Fluid After Transcatheter Arterial Chemoembolization and Microwave Ablation of Hepatocellular Carcinoma in a Peritoneal Dialysis Patient: A Case Report
Session Information
- Peritoneal Dialysis: Inflammation, Peritoneal Transport
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 703 Dialysis: Peritoneal Dialysis
Authors
- Shaikh, Aisha, James J. Peters Medical Center VA, New York, New York, United States
- Chopra, Rebaika, James J. Peters VA Medical Center, Bronx, New York, United States
- George, Jeremy D., Icahn School of Medicine at Mount Sinai, New York, New York, United States
- Gross, Jonathan, New York University-Langone Medical Center, New York, New York, United States
Introduction
Hepatitis C is a risk factor for hepatocellular carcinoma (HCC). The prevalence of Hepatitis C is high among end stage renal disease (ESRD) patients, and these patients are at high risk for developing HCC. In the past decade, transcatheter arterial chemoembolization (TACE) combined with microwave ablation (MA) have emerged as an effective therapy for HCC. These therapies can decrease the tumor burden while patients are on the liver transplant wait-list. Here we present an ESRD patient on peritoneal dialysis who developed a high white blood cell count in the peritoneal fluid following the TACE and MA procedure
Case Description
A 63-year old male with ESRD on Peritoneal Dialysis (PD), and cirrhosis due to Hepatitis C was diagnosed with HCC. At the time of the HCC diagnosis, the patient was listed for a combined liver-kidney transplant. The patient underwent TACE and MA, but immediately following the procedure he developed fever (101°F) which subsided within 24 hours. As part of the fever workup, the peritoneal fluid was sent for white blood cell (WBC), gram stain and culture. The peritoneal fluid WBC was found to be elevated: 1131 (57% PMN, 19% lymphocytes), remaining elevated for more than a month. Notably, it was not accompanied by any associated signs or symptoms such as abdominal pain or cloudy peritoneal fluid. The peritoneal fluid gram stain and culture remained negative, and the patient was able to continue PD without any problems
Discussion
TACE induces ischemic necrosis through arterial chemoembolization, and MA induces coagulative necrosis through thermal ablation. The most common complications of these therapies include fever and abdominal pain likely related to underlying tumor necrosis. It is important for Nephrologists to be aware of the complications related to these therapies, as was seen in our patient who developed an elevated WBC count in the peritoneal fluid. However, this persistent WBC elevation was not accompanied by abdominal pain, cloudy fluid, infection, and did not warrant PD catheter removal or cessation of PD. To the best of our knowledge, this is the first reported case of elevated WBC in peritoneal fluid in a PD patient following the TACE and MA procedure