Published online Jun 28, 2020. doi: 10.3748/wjg.v26.i24.3472
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
Hepatic sinusoidal obstruction syndrome (HSOS) is a hepatic vascular disease in which edema, necrosis, and shedding of endothelial cells and formation of microthrombi occur in the hepatic sinusoids, hepatic venules, and interlobular vein, leading to intrahepatic congestion, liver dysfunction and portal hypertension
Treatments for HSOS are limited.
This study was to evaluate transjugular intrahepatic portosystemic shunting (TIPS) as a treatment for pyrrolidine alkaloid-related HSOS (PA-HSOS).
This retrospective analysis included patients with PA-HSOS and they were divided into the TIPS and conservative treatment groups.
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.
TIPS may achieve better outcomes than conventional symptomatic treatment in patients with PA-HSOS.
Large-scale, multicenter, randomized controlled trials are needed to confirm the findings.