Good clinical outcomes following transjugular intrahepatic portosystemic stent‐shunts in Budd–Chiari syndrome

Abstract

Summary Background There have been encouraging reports on transjugular intrahepatic portosystemic stent‐shunt (TIPSS) for Budd–Chiari syndrome (BCS). Long‐term data are lacking. Aim To assess long‐term outcomes and validate prognostic scores following TIPSS for BCS. Methods A single centre retrospective study. Patients underwent TIPSS using bare or polytertrafluoroethane (PTFE)‐covered stents. Results Sixty‐seven patients received successful TIPSS between 1996 and 2012 using covered (n = 40) or bare (n = 27) stents. Patients included had a Male: Female ratio of 21:46, and were characterised (mean ± s.d.) by age 39.9 ± 14.3 years, Model of end stage liver disease (MELD) 16.1 ± 7.0 and Child's score 8.8 ± 2.0. Seventy‐eight percent had haematological risk factors. Presenting symptoms were ascites (n = 61) and variceal bleeding (n = 6). Nine patients underwent hepatic vein dilatation or stenting prior to TIPSS. Mean follow‐up was 82 months (range 0.5–184 months). Fifteen percent had post‐TIPSS encephalopathy. Two have been transplanted. Primary patency rates (76% vs. 27%, P < 0.001) and shunt re‐interventions (22% vs. 100%, P < 0.001) significantly favoured covered stents. Secondary patency was 99%. Six‐, 12‐, 24‐, 60‐ and 120‐month survival was 97%, 92%, 87%, 80% and 72% respectively. Six patients had liver related deaths. Two 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. Conclusions 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.

Budd‐Chiari syndrome

“…70 The UKbased retrospective study confirms that a high BCS-TIPS score is associated with a significant increase in mortality, but negates the use of other prognostic indices. 79 These extremely high-risk patients often have hepatic encephalopathy, thus presenting with fulminant hepatic failure from the onset. 15 A recent follow-up of the EN-Vie cohort illustrated that with this stepwise management up to 70% of invasive-treated patients received TIPS and only 22% received OLT.…”

Efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPSS) in 40 patients with hepatocellular carcinoma

“…12,13 Refractory ascites, recurrent and also acute variceal bleeding, hepatic hydrothorax, hepatorenal syndrome and Budd-Chiari syndrome are the most common and accepted indications for TIPSS implantation. [14][15][16][17][18][19][20][21][22][23][24] Next to absolute contraindications for TIPSS insertion such as right heart failure, severe hepatic failure, systemic infection and uncontrolled hepatic encephalopathy, hepatic malignancy is considered a relative contraindication. 12,25 Of note, few studies with small sample size investigated the implantation of TIPSS in patients with hepatic malignancy including primary liver cancers as well as hepatic metastases from extrahepatic malignancies.…”

Timing of transjugular intrahepatic portosystemic shunt for Budd-Chiari syndrome: An Italian hepatologist’s perspective

“…LT is used as a rescue therapy, while surgical treatments are rarely contemplated [1][2][3][4] . Surgical shunts for BCS can be very successful, although they are associated with rapid decompensation and high in-hospital mortality (about 25%), primarily due to the patients' poor general condition [29][30][31][32] . Previously, surgery was considered the first choice.…”