Purpose
Therapy of unresectable hepatic metastases may include tumor necrosis factor (TNF)-α treatment. Because of its serious systemic side effects, TNF-α is only used in isolated hepatic perfusion. This, however, is a technically demanding procedure with a substantial mortality rate. The infusion of TNF-α via the hepatic artery without hepatic isolation would be less invasive. Systemic side effects, however, have not been studied yet. Therefore, we evaluated in pigs the effects of TNF-α hepatic artery infusion (HAI) on systemic hemodynamics, inflammation, and organ injury.
Methods
Animals were randomized in three groups. In group 1, HAI was performed with 0.9% NaCl (n = 6). In group 2, 20 µg/kg TNF-α (n = 6), and in group 3, 40 µg/kg TNF-α (n = 6) were added. HAI was performed over 15 min, followed by 120 min of observation. Finally, 250 ml hydroxyethylstarch (HAES; 6%) was administered for resuscitation and hemodynamics were analyzed for another 30 min.
Results
Hepatic artery TNF-α infusion did not cause complications such as bleeding, cardiac depression, pulmonary dysfunction, or SIRS. TNF-α induced a 30% decrease of MAP and systemic vascular resistance, as well as a rise in heart rate and endexspiratory pCO2. TNF-α also moderately (10–20%) lowered the cardiac preload and induced a metabolic acidosis, which, however, could easily be controlled. TNF-α HAI did not induce liver toxicity, and all hemodynamic changes normalized either spontaneously within the 120-min observation period, or, at least, after HAES resuscitation.
Conclusions
TNF-α-based HAI, which may represent a minimally invasive alternative to isolated hepatic perfusion, can be performed without early systemic hemodynamic complications.