Long-term outcomes of transjugular intrahepatic portosystemic shunt in Indian patients with Budd–Chiari syndrome

Shalimar, ; Gamanagatti, Shivanand R. ; Patel, Arpan H. ; Kedia, Saurabh ; Nayak, Baibaswata ; Gunjan, Deepak ; Ranjan, Gyan ; Paul, Shashi B. ; Acharya, Subrat K. (2017) Long-term outcomes of transjugular intrahepatic portosystemic shunt in Indian patients with Budd–Chiari syndrome European Journal of Gastroenterology & Hepatology, 29 (10). pp. 1174-1182. ISSN 0954-691X

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Official URL: http://doi.org/10.1097/MEG.0000000000000945

Related URL: http://dx.doi.org/10.1097/MEG.0000000000000945


Background/aim: Transjugular intrahepatic portosystemic shunt (TIPS) is the treatment of choice in Budd-Chiari syndrome (BCS) based on current data. Our objective was to evaluate outcomes and assess prognostic factors in BCS patients undergoing TIPS. Patients and methods: In this retrospective analysis of a propectively maintained database, all consecutive BCS patients undergoing TIPS from September 2010 to February 2017 were included. Complete response after TIPS was defined as resolution of symptoms (ascites/pedal edema) with no requirement of diuretics at the end of 4 weeks. The Cox proportional hazard regression model was used to assess predictors of outcome and complications. Results: Eighty patients with BCS who underwent TIPS were included; 40 (50%) were male. The mean age at onset of symptoms was 24.2±8.7 years. The median (range) follow-up was 660 (2-2400) days. The 1-, 3-, and 5-year rates for TIPS stent patency were 89, 81, and 81%, respectively. Cumulative encephalopathy-free rates were 91, 86, and 86%, respectively, and survival rates were 93, 89, and 84%, respectively. Eight (10.0%) patients died during follow-up, five within the first year (three of these five had incomplete response). On univariate analysis, serum bilirubin, response to intervention, serum creatinine, Child class, model for end-stage liver disease, and All India Institute of Medical Sciences-hepatic venous outflow tract obstruction score were significantly different between survivors and nonsurvivors. On multivariate analysis, response to therapy after TIPS (hazard ratio: 8.37; 95% confidence interval: 1.60-43.82) was independently associated with mortality. The 1-year survival was 97% in patients with complete response, compared with 59% in those with incomplete response (P<0.004). Conclusion: Incomplete symptom response after TIPS is associated with poor outcome and can be used for selection of patients for liver transplantation.

Item Type:Article
Source:Copyright of this article belongs to Wolters Kluwer Health, Inc.
Keywords:angioplasty , ascites , Budd–Chiari syndrome , hepatic vein , hepatic venous outflow tract obstruction , liver transplant , stenting , variceal bleeding
ID Code:128838
Deposited On:22 Nov 2022 09:09
Last Modified:27 Feb 2023 06:39

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