Transjugular intrahepatic portosystemic shunt for pyrrolizidine alkaloid-related hepatic sinusoidal obstruction syndrome

AbstractThere is no specific treatment for pyrrolizidine alkaloid-induced hepatic sinusoidal obstruction syndrome (PA-HSOS). It is not clear when transjugular intrahepatic portosystemic shunt (TIPS) should be implemented in PA-HSOS patients. This study aimed to evaluate the timing of TIPS using total bilirubin (TBIL) as a measure, and to investigate efficacy of TIPS. We retrospectively analyzed the medical records of 10 PA-HSOS patients, among whom 4 patients had received TIPS (TIPS group), and the remaining patients were assigned to the internal medicine group. In the TIPS group, the TBIL level before TIPS was 84.4 ± 45.2 µmol/L (> 3 mg/dL), and TBIL levels were increased to different degrees after TIPS. With the extension of time, serum TBIL levels gradually decreased, and no liver failure occurred. With regards to the short-term outcomes, 3 patients recovered, 1 developed chronic illness and 0 died in the TIPS group. Moreover, 0 patients recovered, 5 developed chronic illness and 1 died in the internal medicine group. The rank sum test of group design revealed significant differences in clinical outcomes (P = 0.02). It was suggested that when the internal medicine effect of PA-HSOS patients is poor, TIPS should be considered, which is no trestricted to the limit of 3 mg/dL TBIL. It was also found TIPS effectively promote the recovery of liver function and reduce the occurrence of chronicity.

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Transjugular Intrahepatic Portosystemic Shunt for Hepatic Sinusoidal Obstruction Syndrome Associated with Consumption of Gynura Segetum

10.21203/rs.3.rs-36169/v1 ◽

2020 ◽

Author(s):

Lijie Zhang ◽

Qing Li ◽

Joyman Makamure ◽

Dan Zhao ◽

Ziyi Liu ◽

...

Keyword(s):

Transjugular Intrahepatic Portosystemic Shunt ◽

Total Bilirubin ◽

Portosystemic Shunt ◽

Sinusoidal Obstruction Syndrome ◽

Liver Size ◽

Hepatic Sinusoidal Obstruction Syndrome ◽

Intrahepatic Portosystemic Shunt ◽

Vein Diameter ◽

Lost To Follow Up

Abstract Background: To evaluate the efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) on hepatic sinusoidal obstruction syndrome (HSOS) associated with consumption of Gynura segetum (GS).Methods: We retrospectively reviewed 9 consecutive patients with GS-related HSOS who were refractory to supportive treatment and underwent TIPS at our institution between January 2014 and September 2019. The patients were evaluated for safety and efficacy, including TIPS complications and changes in portosystemic pressure gradient (PPG), ascites, total bilirubin, liver size and portal vein diameter.Results: TIPS procedures were performed successfully in the 9 patients, without any TIPS technique-related complications. The PPG was improved by TIPS in all patients (mean PPG before TIPS, 30.4 ± 5.2 vs. 13.0 ± 4.1 mm Hg post-TIPS, P=0.008). Except for one patient who was lost to follow-up, the remaining 8 patients survived with a median follow-up period of 12 months (range, 5-39 months). Although the level of total bilirubin was significantly increased 5-7 days after TIPS compared with that before the procedure (3.57 ± 1.58 vs. 4.82 ± 2.06 mg/dl, P=0.017), it returned to baseline level at 1-month follow-up (3.53 ± 2.72 vs. 4.82 ± 2.06 mg/dl, P=0.401). The patients experienced complete resolution or obvious reduction of ascites (P<0.001), significant reduction of liver size (16.7 ± 2.2 vs. 13.7 ± 1.7 cm, P=0.018), and significant enlargement of the portal trunk (10.7 ± 2.5 vs. 13.4 ± 2.4 mm, P=0.017) after TIPS compared to the pre-TIPS state.Conclusion: TIPS may offer a potentially useful treatment for the GS-related HSOS.

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Transjugular Intrahepatic Portosystemic Shunt for Hepatic Sinusoidal Obstruction Syndrome Associated with Consumption of Gynura Segetum

10.21203/rs.3.rs-36169/v2 ◽

2020 ◽

Author(s):

Lijie Zhang ◽

Qing Li ◽

Joyman Makamure ◽

Dan Zhao ◽

Ziyi Liu ◽

...

Keyword(s):

Transjugular Intrahepatic Portosystemic Shunt ◽

Total Bilirubin ◽

Portosystemic Shunt ◽

Sinusoidal Obstruction Syndrome ◽

Liver Size ◽

Hepatic Sinusoidal Obstruction Syndrome ◽

Intrahepatic Portosystemic Shunt ◽

Vein Diameter ◽

Lost To Follow Up

Abstract Background: To evaluate the efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) on hepatic sinusoidal obstruction syndrome (HSOS) associated with consumption of Gynura segetum (GS). Methods: We retrospectively reviewed 9 consecutive patients with GS-related HSOS who were refractory to supportive treatment and underwent TIPS at our institution between January 2014 and September 2019. The patients were evaluated for safety and efficacy, including TIPS complications and changes in portosystemic pressure gradient (PPG), ascites, total bilirubin, liver size and portal vein diameter. Results: TIPS procedures were performed successfully in the 9 patients, without any TIPS technique-related complications. The PPG was improved by TIPS in all patients (mean PPG before TIPS, 30.4 ± 5.2 vs. 13.0 ± 4.1 mm Hg post-TIPS, P=0.008). Except for one patient who was lost to follow-up, the remaining 8 patients survived with a median follow-up period of 12 months (range, 5-39 months). Although the level of total bilirubin was significantly increased 5-7 days after TIPS compared with that before the procedure (3.57 ± 1.58 vs. 4.82 ± 2.06 mg/dl, P=0.017), it returned to baseline level at 1-month follow-up (3.53 ± 2.72 vs. 4.82 ± 2.06 mg/dl, P=0.401). The patients experienced complete resolution or obvious reduction of ascites (P<0.001), significant reduction of liver size (16.7 ± 2.2 vs. 13.7 ± 1.7 cm, P=0.018), and significant enlargement of the portal trunk (10.7 ± 2.5 vs. 13.4 ± 2.4 mm, P=0.017) after TIPS compared to the pre-TIPS state. Conclusion: TIPS may offer a potentially useful treatment for the GS-related HSOS.

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Transjugular intrahepatic portosystemic shunt for hepatic sinusoidal obstruction syndrome associated with consumption of Gynura segetum

BMC Gastroenterology ◽

10.1186/s12876-021-01599-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Lijie Zhang ◽

Qing Li ◽

Joyman Makamure ◽

Dan Zhao ◽

Ziyi Liu ◽

...

Keyword(s):

Transjugular Intrahepatic Portosystemic Shunt ◽

Total Bilirubin ◽

Portosystemic Shunt ◽

Sinusoidal Obstruction Syndrome ◽

Liver Size ◽

Hepatic Sinusoidal Obstruction Syndrome ◽

Intrahepatic Portosystemic Shunt ◽

Noticeable Reduction ◽

Lost To Follow Up

Abstract Background To evaluate the efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) on hepatic sinusoidal obstruction syndrome (HSOS) associated with consumption of Gynura segetum (GS). Methods We retrospectively reviewed 9 consecutive patients with GS-related HSOS who were refractory to supportive treatment and underwent TIPS at our institution between January 2014 and September 2019. The patients were evaluated for safety and efficacy, including TIPS complications and changes in portosystemic pressure gradient (PPG), ascites, total bilirubin, liver size and portal vein diameter. Results TIPS procedures were performed successfully in the 9 patients, and no technically-related complications due to the TIPS procedure were recorded. The PPG was improved by TIPS in all patients (mean PPG before TIPS, 30.4 ± 5.2 vs. 13.0 ± 4.1 mm Hg post-TIPS, P = 0.008). One patient who was lost to follow-up, whereas the remaining 8 patients survived with a median follow-up period of 12 months (range 5–39 months). Although the total bilirubin was significantly increased 5–7 days after TIPS compared with that before the procedure (3.57 ± 1.58 vs. 4.82 ± 2.06 mg/dl, P = 0.017), it returned to baseline levels at 1-month follow-up (3.53 ± 2.72 vs. 4.82 ± 2.06 mg/dl, P = 0.401). The patients experienced complete resolution or noticeable reduction of ascites (P < 0.001), significant reduction of liver size (16.7 ± 2.2 vs. 13.7 ± 1.7 cm, P = 0.018), and significant enlargement of the portal trunk (10.7 ± 2.5 vs. 13.4 ± 2.4 mm, P = 0.017) after TIPS compared to the pre-TIPS state. Conclusion TIPS may offer a potentially useful treatment for the GS-related HSOS.

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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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