Purpose: While transjugular intrahepatic portosystemic shunt (TIPS) has been shown to relieve hepatic venous obstruction and is a viable alternative to liver transplantation (LT) in Budd-Chiari syndrome (BCS), the effect of TIPS on liver function in patients with BCS is unclear, particularly outside the immediate post-treatment period.
Materials and Methods: 20 patients with BCS who underwent TIPS from 1999-2018 were included. Demographic data and clinical data at the time of TIPS procedure, 6-month, and 12-month post TIPS were collected.
Results: There were 13 (65%) women and 7 (35%) men with a mean age of 42.6 ± 12.8 years. 8 (40%) patients had a JAK-2 mutation. Time from BCS diagnosis to TIPS procedure was 10.3 ± 23.3 months. Median follow-up time was 8.4 years. The ascitic burden significantly decreased from pre-TIPS (moderate ascites 10/17 (58.8%)) at 6 (moderate ascites 1/16 (6.3%), p=0.0001) and 12 (1/13 (7.7%, p=0.0007)) months follow-up, respectively. Hepatic encephalopathy was present in 5/17 (29.4%) pre-TIPS, 3/16 (18.8%) 6-month post TIPS, and 4/13 (30.8%) 12-months post-TIPS. Serum albumin significantly improved from pre-TIPS (3.0±0.6) through 6 (3.5±0.7 (p=0.03)) and 12 (3.7±0.6 (p< 0.01)) month follow up. Similarly, total protein significantly improved at 6-months after TIPS (pre-TIPS 6.4±1.4, 6-mo 7.3±1 (p= 0.03)). Child-Pugh Score significantly decreased with a score of 9.4 ± 1.8 pre-TIPS, as compared to 7.6 ± 1.8 at 6-months (p=0.007), and 7.4 ± 1.5 (p=0.05) at 12-months post TIPS. 15 (75%) patients required TIPS revision with 4/15 (26.7%) within 30 days; 2/15 (13.3%) between 1 month & 1 year, and 9/15 (69.2%) after 1 year. 8 (40%) patients underwent LT at mean 7.68 ± 6 years after TIPS. 3 (15%) patients died at 1.9, 9.8, and 16.9 years following TIPS.
Conclusion: In patients with BCS, TIPS significantly resolves symptoms and improves liver synthetic function at 1-year. Despite the frequent need for revision, TIPS for BCS also has good long-term durability and is able to prolong time to LT in a large proportion of patients.
.png)
.png)
.png)