Copyright
©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
Transjugular intrahepatic portosystemic shunt for pyrrolizidine alkaloid-related hepatic sinusoidal obstruction syndrome
Chun-Ze Zhou, Rui-Feng Wang, Wei-Fu Lv, Yu-Qin Fu, De-Lei Cheng, Yi-Jiang Zhu, Chang-Long Hou, Xian-Jun Ye
Chun-Ze Zhou, Wei-Fu Lv, Interventional Radiology, Medical College of Shandong University, Jinan 250021, Shandong Province, China
Chun-Ze Zhou, Wei-Fu Lv, De-Lei Cheng, Yi-Jiang Zhu, Chang-Long Hou, Interventional Radiology Department, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, Anhui Province, China
Rui-Feng Wang, Yu-Qin Fu, Department of Nephrology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250033, Shandong Province, China
Xian-Jun Ye, Department of Ultrasound, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, Anhui Province, China
Author contributions: Zhou CZ and Wang RF contributed equally to this article; Zhou CZ, Wang RF and Ye XJ drafted the manuscript; Lv WF, Fu YQ and Cheng DL participated in design and oversight of the study; Lv WF, Fu YQ, Cheng DL, Zhu YJ and Hou CL were involved with data collection; Zhou CZ, Wang RF, Zhu YJ, Hou CL and Ye XJ assisted with data analysis; all authors read and approved the final manuscript.
Supported by China Hepatitis Prevention and Treatment Foundation Scientific Research Subject, No. TQGB20180247; and Anhui Province Natural Science Foundation Projects, No. 1808085MH254.
Institutional review board statement: The study was approved by the Medical Research Ethics Committee of the First Affiliated Hospital of USTC.
Informed consent statement: The study was exempted from informed consent because it was retrospective and anonymized.
Conflict-of-interest statement: We have no financial relationships to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Wei-Fu Lv, MD, Doctor, Interventional Radiology Department, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, No, 17, Lujiang Road, Hefei 230001, Anhui Province, China. weifulv@ustc.edu.cn
Received: January 22, 2020
Peer-review started: January 22, 2020
First decision: March 6, 2020
Revised: April 30, 2020
Accepted: May 15, 2020
Article in press: May 15, 2020
Published online: June 28, 2020
BACKGROUND
Treatments for hepatic sinusoidal obstruction syndrome (HSOS) are limited.
AIM
To evaluate transjugular intrahepatic portosystemic shunting (TIPS) as a treatment for pyrrolidine alkaloid-related HSOS (PA-HSOS).
METHODS
This retrospective analysis included patients with PA-HSOS admitted to the First Affiliated Hospital of the University of Science and Technology of China (June 2015 to January 2019). Baseline clinical characteristics and follow-up data were extracted from the medical records. All patients included in this study experienced failure of initial therapy. Patients were divided into the TIPS and conservative treatment groups according to the therapy they received. Liver function, maximal ascites depth, imaging characteristics, pathology findings, and survival were compared between groups.
RESULTS
The TIPS group included 37 patients (28 males), and the conservative treatment group included 17 patients (11 males). Baseline characteristics were similar between groups. There were two deaths in the TIPS group and seven deaths in the conservative treatment group during follow-up (3-48 mo). The 3-, 6-, 12- and 24-mo survival rates were 94.6%, 94.6%, 94.6% and 94.6%, respectively, in the TIPS group and 70.6%, 57.8%, 57.8% and 57.8%, respectively, in the conservative treatment group. Kaplan-Meier analysis revealed significantly longer survival for the TIPS group than for the conservative treatment group (P = 0.001). Compared with the pre-treatment value, maximal ascites depth was significantly lower at 1 wk, 2 wk, 1 mo, and 3 mo for the TIPS group (all P < 0.05) but not in the conservative treatment group. Contrast-enhanced computed tomography demonstrated the disappearance of patchy liver enhancement after TIPS. Pathology showed that liver congestion and hepatocyte swelling improved with time after TIPS placement.
CONCLUSION
TIPS may achieve better outcomes than conventional symptomatic treatment in patients with PA-HSOS.
Core tip: Kaplan-Meier analysis revealed significantly longer survival for the transjugular intrahepatic portosystemic shunting (TIPS) group than for the conservative treatment group in this retrospective study. Compared with the pre-treatment value, maximal ascites depth was significantly lower at 1 wk, 2 wk, 1 mo, and 3 mo for the TIPS group (all P < 0.05) but not the conservative treatment group. Contrast-enhanced computed tomography demonstrated the disappearance of patchy liver enhancement after TIPS.
