Long-term efficacy of Transjugular Intrahepatic Portosystemic Shunt treatment for Budd-Chiari Syndrome

Stavros Spiliοpoulos, Charalampos Lalenis, Chrysostomos Konstantos, Konstantinos Palialexis, Maria Tsitskari, Lazaros Reppas, Elias Brountzos

Abstract


Purpose: To investigate long-term efficacy of transjugular intrahepatic porto-systemic shunt (TIPS) creation for the management of symptomatic Budd Chiari Syndrome (BCS) refractory to drug therapy.

Material and methods: This is a retrospective, single-centre analysis of 27 consecutive patients (17 female and 10 male patients; mean age: 50.8 ± 15.0 years) who underwent TIPS, between July 2003 and June 2016, due to symptomatic BCS not responding to anticoagulation therapy. Model for end-stage liver disease (MELD) score, BCS-TIPS prognostic index (BSC-TIPS PI) scores and procedural details were recorded. Primary outcome measure was orthotopic liver transplant (OLT)-free survival. Secondary outcome measures included primary patency (PP) and reintervention-free interval as well as the identification of factors influencing outcomes.

Results: Mean time follow-up was 46.5 ± 38.7 months (range 1-139). Mean MELD and BSC-TIPS PI scores were 13.8 ± 4.9 (range 6-25) and 4.9 ± 1.3 (range: 3.25 to 8.48) respectively. According to Kaplan-Meier survival analysis, estimated OLT-free survival rates were 96.3%, 96.3%, 82.5% at 2, 5 and 10 years follow up respectively. PP was 77.4%, 55.3% and 26.3% and reintervention-free interval was 80.4%, 57.4% and 30.8% at 1, 2 and 8 years follow up, respectively. Univariate subgroup analysis demonstrated that stent grafts were correlated with increased survival (HR: 0.0045; 95% CI 0.00003 to 0.701; p=0.035) and PP (HR: 0.36; 95% CI 2.503 to 3.053; p=0.03).

Conclusions: TIPS achieved high long-term OLT-free survival and satisfactory reintervention rates in patients with symptomatic BCS refractory to anticoagulation. Stent graft use was correlated with increased survival and primary patency.


Keywords


Budd-Chiari syndrome; hepatic veins occlusion, Transjugular Intrahepatic Portosystemic Shunt (TIPS); orthotopic liver transplantation, stent graft

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