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

doi:10.3748/wjg.v26.i24.3472

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

World J Gastroenterol. Jun 28, 2020; 26(24): 3472-3483
Published online Jun 28, 2020. doi: 10.3748/wjg.v26.i24.3472

Table 1 Baseline clinical characteristics of the patients in the two groups

Characteristic	TIPS group (n = 37)	Conservative treatment group (n = 17)	P value
Gender (male/female)	28/9	11/6	0.403
Age (yr)	62.30 ± 10.91	60.18 ± 15.37	0.563
Onset-to-treatment time (d)	28.57 ± 15.26	26.18 ± 12.44	0.535
MELD score	12.13 ± 5.32	12.76 ± 4.96	0.683
Early therapeutic regimen
Reduced glutathione	37 (100)	17 (100)	NA
Ademetionine	37 (100)	17 (100)	NA
Diuretics	37 (100)	17 (100)	NA
Low molecular weight heparin	37 (100)	17 (100)	NA
Glucocorticoids	11 (29.73)	6 (35.29)	0.757
Antibacterial drugs,	23 (62.16)	12 (70.60)	0.549
Clinical symptoms on admission
Ascites (yes/no)	37/0	17/0	NA
Hepatomegaly (yes/no)	26/11	10/7	0.407
Hepatalgia (yes/no)	15/22	7/10	0.965
Peritonitis (yes/no)	7/30	2/15	0.512
Loss of appetite (yes/no)	34/3	15/2	0.667
Gastrointestinal bleeding (yes/no)	1/36	0/17	0.494
Weight gain (yes/no)	12/25	6/11	0.836
Laboratory indicators at 2 wk
Total bilirubin (μmol/L)	53.3 (39.8)	53.6 (45.0)	0.904
Direct bilirubin (μmol/L)	32.4 (32.6)	37.4 (47.0)	0.520
Alanine transaminase (U/L)	45.0 (69.0)	55.0 (86.0)	0.342
Aspartate transaminase (U/L)	65.0 (48.0)	62.0 (89.0)	0.628
Gamma-glutamyl transferase (U/L)	125.0 (90.0)	91.0 (94.0)	0.099
Alkaline phosphatase (U/L)	112.6 (60.0)	95.0 (91.0)	0.087
Albumin (g/L)	31.32 ± 3.38	31.95 ± 4.92	0.588
Prothrombin time (s)	15.81 ± 3.64	16.75 ± 2.28	0.342
White blood cell count (10⁹/L)	6.75 ± 3.05	6.66 ± 2.20	0.913
Neutrophil proportion (%)	64.19 ± 12.16	64.39 ± 10.70	0.955
Red blood cell count (10¹²/L)	4.91 ± 0.81	4.49 ± 0.63	0.064
Platelet count (10⁹/L)	108.0 (49.0)	90.0 (68.0)	0.165
Blood urea nitrogen (mmol/L)	6.8 (3.4)	5.6 (4.3)	0.252
Creatinine (μmol/L)	67.6 (32.0)	75.0 (35.0)	0.780
Maximum depth of ascites (mm)	95.22 ± 22.58	81.65 ± 26.29	0.057

Data are presented as mean ± standard deviation, median (interquartile range) or n (%). MELD: Model for end-stage liver disease; TIPS: Transjugular intrahepatic portosystemic shunting; NA: Not available.

Table 2 Results of liver function tests for patients in the two groups

Group and time point	TBil (μmol/L)	DBil (μmol/L)	ALT (U/L)	AST (U/L)
TIPS group
Before treatment (n = 37)	53.30 (39.80)	32.40 (32.60)	45.00 (69.00)	65.00 (48.00)
1 wk after treatment (n = 36)	60.20 (70.60)	44.85 (49.43)	40.50 (53.00)	59.00 (65.00)
2 wk after treatment (n = 35)	56.40 (30.40)	35.20 (28.40)	36.00 (26.00)	47.00 (17.00)^a
1 mo after treatment (n = 35)	47.20 (13.70)^c	29.20 (14.10)^c	26.00 (20.00)^a^c^e	40.00 (16.00)^a^c
3 mo after treatment (n = 35)	44.20 (9.70)^c	27.40 (13.10)^c	31.00 (11.00)	41.00 (12.00)^a^c
P value	< 0.05	< 0.05	< 0.05	< 0.05
Conservative treatment group
Before treatment (n = 17)	53.60 (45.00)	37.40 (47.00)	55.00 (86.0)	62.00 (89.00)
1 wk after treatment (n = 17)	67.80 (41.60)	43.60 (35.95)	56.00 (99.00)	67.00 (109.00)
2 wk after treatment (n = 16)	52.25 (71.30)	37.60 (60.30)	44.00 (42.00)	53.50 (44.00)
1 mo after treatment (n = 16)	44.40 (39.24)	31.20 (31.80)	34.50 (44.00)	41.50 (50.00)
3 mo after treatment (n = 12)	38.15 (37.95)	26.00 (35.80)	25.00 (55.00)	39.00 (64.00)
P value	> 0.05	> 0.05	> 0.05	> 0.05

Data are presented as median (interquartile range). ALT: Alanine transaminase; AST: Aspartate transaminase; DBil: Direct bilirubin; TBil: Total bilirubin; TIPS: Transjugular intrahepatic portosystemic shunting.

^aP < 0.05 vs the value before treatment.

^cP < 0.05 vs the value 1 wk after treatment.

^eP < 0.05 vs the value 2 wk after treatment.

Table 3 Results of ascites depth for patients in the two groups

Group and time point	Ascites depth (mm)
TIPS group
Before treatment (n = 37)	95 (30)
1 wk after treatment (n = 36)	35 (35)^c
2 wk after treatment (n = 35)	0 (13)^a^c
1 mo after treatment (n = 35)	0 (0)^a^c
3 mo after treatment (n = 35)	0 (0)^a^c
P value	< 0.001
Conservative treatment group
Before treatment (n = 17)	85 (20)
1 wk after treatment (n = 17)	71 (34)
2 wk after treatment (n = 16)	69.5 (37)
1 mo after treatment (n = 16)	56.5 (53)
3 mo after treatment (n = 12)	31 (74)
P value	0.158

Data are presented as median (interquartile range).

^aP < 0.05 vs the value before treatment.

^cP < 0.05 vs the value 1 wk after treatment.

Table 4 Comparison of treatment outcomes between the two groups during follow up

Outcome	TIPS group (n = 37)	Conservative treatment group (n = 17)	P value
Spontaneous peritonitis (yes/no)	3/34	9/8	< 0.001
Pyemia (yes/no)	1/36	4/13	0.014
Liver failure (yes/no)	3/34	6/11	0.013
Gastrointestinal bleeding (yes/no)	0/37	1/16	0.136
Multiple organ failure (yes/no)	0/37	2/15	0.033
Hepatic encephalopathy (yes/no)	8/29	1/16	0.149
Main portal vein thrombosis (yes/no)	0/37	1/16	0.136
Intraoperative bleeding (yes/no)	1/36	0/2	0.814
Stenosis of shunt channel (yes/no)	0/37	0/2	NA
Attributable deaths (death/survival)	2/35	7/10	0.001
Cause of death
Pyemia (yes/no)	1/36	3/14	0.051
Liver failure (yes/no)	1/36	2/15	0.177
Gastrointestinal bleeding (yes/no)	0/37	1/16	0.136
Multiple organ failure (yes/no)	0/37	2/15	0.033

TIPS: Transjugular intrahepatic portosystemic shunting; NA: Not available.

Citation: Zhou CZ, Wang RF, Lv WF, Fu YQ, Cheng DL, Zhu YJ, Hou CL, Ye XJ. Transjugular intrahepatic portosystemic shunt for pyrrolizidine alkaloid-related hepatic sinusoidal obstruction syndrome. World J Gastroenterol 2020; 26(24): 3472-3483
URL: https://www.wjgnet.com/1007-9327/full/v26/i24/3472.htm
DOI: https://dx.doi.org/10.3748/wjg.v26.i24.3472