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Good outcomes after transjugular intrahepatic portosystemic stent-shunts in Budd–Chiari syndrome

The latest issue of the Alimentary Pharmacology & Therapeutics reports good clinical outcomes following transjugular intrahepatic portosystemic stent-shunts in Budd–Chiari syndrome.

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There have been encouraging reports on transjugular intrahepatic portosystemic stent-shunt (TIPSS) for Budd–Chiari syndrome (BCS). Long-term data are lacking.

Dr Tripathi and colleagues from the United Kingdom assessed long-term outcomes and validate prognostic scores following TIPSS for BCS.

The research team performed a single center retrospective study.

Patients underwent TIPSS using bare or polytertrafluoroethane (PTFE)-covered stents.

The team reported that 67 patients received successful TIPSS between 1996 and 2012 using covered or bare stents.

The researchers found that 78% had hematological risk factors.

Presenting symptoms were ascites, and variceal bleeding.

Secondary patency was 99%
Alimentary Pharmacology & Therapeutics

The team noted that 9 patients underwent hepatic vein dilatation or stenting prior to TIPSS.

Mean follow-up was 82 months.

The research team found that 15% had post-TIPSS encephalopathy.

The team observed that 2 patients have been transplanted.

Primary patency rates and shunt re-interventions significantly favoured covered stents.

Secondary patency was 99%.

The research team found that 6-, 12-, 24-, 60- and 120-month survival was 97%, 92%, 87%, 80% and 72%, respectively.

The researchers observed that 6 patients had liver related deaths.

The team noted that 2 patients developed hepatocellular carcinoma.

The BCS TIPS PI independently predicted mortality in the whole cohort, but no prognostic score was a significant predictor of mortality after subgroup validation.

Dr Tripathi's team concludes, "Long-term outcomes following TIPSS for Budd–Chiari syndrome are very good."

"PTFE-covered stents have significantly better primary patency."

"The value of prognostic scores is controversial."

"TIPSS should be considered as first line therapy in symptomatic patients in whom hepatic vein patency cannot be restored."

Aliment Pharmacol Ther 2014: 39(8): 864–872
31 March 2014

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