Intractable ascites without mechanical vascular obstruction after orthotopic liver transplantation: etiology and clinical outcome of sinusoidal obstruction syndrome

Orthotopic liver transplantation (OLT) has become a standard procedure for end-stage cirrhosis. The purpose of this anlysis is to give a brief overview on the clinical outcome of OLT. According to a current survey of primary indications for liver transplantation in Europe, virus-induced cirrhosis represents the largest proportion with 25%. The next frequent indication is alcoholic cirrhosis with 19%. Cholestatic diseases amount to 13%, malignancy in cirrhosis 10%, and acute hepatic failure 10%. The outcome of these main indications will be discussed and critical considerations pointed out. Patient survival rates demonstrate for cirrhosis at 1-and 5-year about 80% and 70%, respectively. In acute hepatic failure, more patients are lost in the perioperative period. Not surprisingly, patients transplanted for malignancy show decreased long-term survival. Considering an average of 5-year survival in patients with end-stage liver disease of 20% or less, excellent patient survival can be achieved by liver transplantation.

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Survival in Patients with Pyrrolizidine Alkaloids-Induced Hepatic Sinusoidal Obstruction Syndrome Versus Other Causes of Portal Hypertension in the Treatment of Transjugular Intrahepatic Portosystemic Shunt Placement: A Propensity Score Matching Study

10.21203/rs.3.rs-152407/v1 ◽

2021 ◽

Author(s):

Yiran Chen ◽

Wei Zhang ◽

Ming Zhang ◽

Feng Zhang ◽

Jiangqiang Xiao ◽

...

Keyword(s):

Liver Transplantation ◽

Portal Hypertension ◽

Propensity Score ◽

Orthotopic Liver Transplantation ◽

Transjugular Intrahepatic Portosystemic Shunt ◽

Portosystemic Shunt ◽

Sinusoidal Obstruction Syndrome ◽

Free Survival ◽

Hepatic Sinusoidal Obstruction Syndrome ◽

Intrahepatic Portosystemic Shunt

Abstract Background/purpose: The etiology of portal hypertension may be an important factor affecting patient outcomes after transjugular intrahepatic portosystemic shunt (TIPS) treatment. Pyrrolizidine alkaloid-induced hepatic sinusoidal obstruction syndrome (PA-HSOS) is characterized by acute portal hypertension and liver injury. The aim of this study was to compare the post-TIPS survival between patients with PA-HSOS and those with other etiologies of hepatic portal hypertension. Methods: A retrospective file review of 787 patients with portal hypertension-related complications, including 146 patients with PA-HSOS, who had received TIPS treatment at our institution between August 2008 to September 2020 was performed. We recorded the demographic and clinical characteristics of patients before TIPS. The median follow-up was 20.27 months. Orthotopic liver transplantation (OLT)-free survival was compared between PA-HSOS and non-HSOS patients. Propensity score matching (PSM) was used to minimize bias.Results: Compared to patients with other etiologies of portal hypertension, PA-HSOS patients had a statistically significantly higher Child-Pugh and model for end-stage liver disease score. No significant differences were found in the orthotopic liver transplantation (OLT)-free survival between patients with PA-HSOS and patients with other causes of portal hypertension (all P > 0.05). After PSM, OLT-free survival was significantly better in PA-HSOS patients than in patients with viral hepatitis (P = 0.0011), primary biliary cirrhosis or autoimmune hepatitis (P = 0.021), and schistosomiasis (P = 0.025).Conclusions: TIPS placement can be performed safely in patients with PA-HSOS. PA-HSOS patients had a better or similar prognosis after TIPS treatment than patients with portal hypertension of other etiologies.Trial registration: This study was retrospectively registered in the chictr.Org database (ChiCTR2000040899) in 14 December 2020.

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