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 16 January 2018

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News

TIPS improves survival in patients with Budd-Chiari syndrome

A study in this month’s issue of Gastroenterology examines long-term results of transjugular intrahepatic portosystemic shunt for Budd-Chiari Syndrome.

News image

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Budd-Chiari syndrome is a rare and life-threatening disorder secondary to hepatic venous outflow obstruction.

Small series of Budd-Chiari syndrome patients indicate that transjugular intrahepatic portosystemic shunt may be useful.

1-year liver transplant-free survival was 88%
Gastroenterology

The influence of transjugular intrahepatic portosystemic shunt (TIPS) on patient survival, and factors that predict the outcome of transjugular intrahepatic portosystemic shunt in Budd-Chiari syndrome patients remain unknown.

Dr Juan Carlos Garcia–Pagán and colleagues from Spain followed 124 consecutive Budd-Chiari syndrome patients treated with transjugular intrahepatic portosystemic shunt.

The patients were observed in 6 European centers between 1993 and 2006 until death, orthotopic liver transplantation, or last clinical evaluation.

The researchers found that prior to treatment with transjugular intrahepatic portosystemic shunt, Budd-Chiari syndrome patients had a high Model of End Stage Liver Disease and high Rotterdam Budd-Chiari syndrome prognostic index indicating severity of liver dysfunction.

However, 1- and 5-year orthotopic liver transplantation-free survival were 88% and 78%, respectively.

The team found that in the high-risk patients, 5-year orthotopic liver transplantation-free survival was much better than that estimated by the Rotterdam Budd-Chiari syndrome index.

In the whole population, bilirubin, age, and international normalized ratio for prothrombin time independently predicted 1-year orthotopic liver transplantation-free survival.

A prognostic score with a good discriminative capacity was developed from these variables.

The team noted that 7 out of 8 patients with a score over 7 died or underwent transplantation vs 5 out of 114 patients with a score less than 7.

Dr Garcia–Pagán's team concluded, “Long-term outcome for patients with severe Budd-Chiari syndrome treated with transjugular intrahepatic portosystemic shunt is excellent even in high-risk patients, suggesting that transjugular intrahepatic portosystemic shunt may improve survival.”

“We identified a small subgroup of Budd-Chiari syndrome patients with poor prognosis despite transjugular intrahepatic portosystemic shunt who might benefit from early orthotopic liver transplantation.”

Gastroenterology 2008: 135(3): 808-15


17 September 2008

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