Transjugular intrahepatic portosystemic shunt for pyrrolizidine alkaloid-related hepatic sinusoidal obstruction syndrome

Treatments for hepatic sinusoidal obstruction syndrome (HSOS) are limited. To evaluate transjugular intrahepatic portosystemic shunting (TIPS) as a treatment for pyrrolidine alkaloid-related HSOS (PA-HSOS). This retrospective analysis included patients with PA-HSOS admitted to the First Affiliated H...

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Bibliographic Details
Published in:World journal of gastroenterology : WJG 2020-06, Vol.26 (24), p.3472-3483
Main Authors: Zhou, Chun-Ze, Wang, Rui-Feng, Lv, Wei-Fu, Fu, Yu-Qin, Cheng, De-Lei, Zhu, Yi-Jiang, Hou, Chang-Long, Ye, Xian-Jun
Format: Article
Language:English
Subjects:
Ascites
China
Hepatic Veno-Occlusive Disease - drug therapy
Hepatic Veno-Occlusive Disease - etiology
Humans
Male
Portasystemic Shunt, Transjugular Intrahepatic - adverse effects
Pyrrolizidine Alkaloids
Retrospective Studies
Retrospective Study
Treatment Outcome
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Summary:Treatments for hepatic sinusoidal obstruction syndrome (HSOS) are limited. To evaluate transjugular intrahepatic portosystemic shunting (TIPS) as a treatment for pyrrolidine alkaloid-related HSOS (PA-HSOS). This retrospective analysis included patients with PA-HSOS admitted to the First Affiliated Hospital of the University of Science and Technology of China (June 2015 to January 2019). Baseline clinical characteristics and follow-up data were extracted from the medical records. All patients included in this study experienced failure of initial therapy. Patients were divided into the TIPS and conservative treatment groups according to the therapy they received. Liver function, maximal ascites depth, imaging characteristics, pathology findings, and survival were compared between groups. The TIPS group included 37 patients (28 males), and the conservative treatment group included 17 patients (11 males). Baseline characteristics were similar between groups. There were two deaths in the TIPS group and seven deaths in the conservative treatment group during follow-up (3-48 mo). The 3-, 6-, 12- and 24-mo survival rates were 94.6%, 94.6%, 94.6% and 94.6%, respectively, in the TIPS group and 70.6%, 57.8%, 57.8% and 57.8%, respectively, in the conservative treatment group. Kaplan-Meier analysis revealed significantly longer survival for the TIPS group than for the conservative treatment group ( = 0.001). Compared with the pre-treatment value, maximal ascites depth was significantly lower at 1 wk, 2 wk, 1 mo, and 3 mo for the TIPS group (all < 0.05) but not in the conservative treatment group. Contrast-enhanced computed tomography demonstrated the disappearance of patchy liver enhancement after TIPS. Pathology showed that liver congestion and hepatocyte swelling improved with time after TIPS placement. TIPS may achieve better outcomes than conventional symptomatic treatment in patients with PA-HSOS.
ISSN:1007-9327
2219-2840
DOI:10.3748/wjg.v26.i24.3472