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Long-term portosystemic shunt patency as a determinant of outcome in Budd-Chiari syndrome
Jean-Baptiste Bachet1, Bertrand Condat, Hervé Hagège
1Service d'hépatologie, Hôpital Beaujon, 100 Bd du Général-Levelerc, 92118 Clichy Cedex, France.
Insights
Shunt dysfunction significantly worsens outcomes for Budd-Chiari syndrome patients undergoing surgical shunting, increasing complications and mortality. Successful shunt revision can restore positive outcomes, highlighting the importance of monitoring shunt patency.
Area of Science:
- Hepatology
- Vascular Surgery
- Gastroenterology
Background:
- Portosystemic shunting is a primary treatment for Budd-Chiari syndrome.
- The long-term consequences of shunt dysfunction after surgical shunting are not well-established.
Purpose of the Study:
- To evaluate the long-term impact of shunt dysfunction on morbidity and mortality in patients with Budd-Chiari syndrome who underwent surgical shunting.
Main Methods:
- Analysis of 39 consecutive patients who underwent surgical shunting between 1978 and 2000.
- Utilized a time-dependent multivariate Cox model for data analysis.
- Median follow-up duration was 110 months.
Main Results:
- Shunt dysfunction was associated with significantly higher rates of refractory ascites (18 vs. 1), variceal bleeding (7 vs. 1), and mortality or liver transplantation (11 vs. 3).
- Prosthetic shunts and high preshunt portal venous pressure predicted shunt dysfunction.
- Shunt dysfunction led to significantly shorter survival (p=0.001).
- Successful shunt revision in seven patients with dysfunction eliminated refractory ascites and end-stage liver disease mortality.
Conclusions:
- Shunt dysfunction critically impacts morbidity and mortality in Budd-Chiari syndrome patients treated with portosystemic shunting.
- Monitoring and timely revision of shunts are crucial for improving long-term patient outcomes.
Background/Aims:
Portosystemic shunting, whether surgical or transjugular intrahepatic, has been a cornerstone of therapy for Budd-Chiari syndrome. However, the long-term impact of shunt dysfunction remains unknown. We have assessed this long-term impact in patients with surgical shunting.
Methods:
Thirty-nine consecutive patients operated on between 1978 and 2000 were analyzed using time-dependent multivariate Cox model.
Results:
Median follow-up was 110 months. Prosthetic shunts and high preshunt portal venous pressure were predictors of subsequent shunt dysfunction. Among 19 patients with persistently patent shunt, as compared to 20 patients with shunt dysfunction, 1 versus 18 developed refractory ascites; 1 versus 7 had variceal bleeding; 7 versus 2 had encephalopathy; 3 versus 11 (55%) died or underwent liver transplantation; and 0 versus 10 died from end-stage liver disease. Shunt dysfunction was associated with a shorter survival (p=0.001). Out of 20 patients with shunt dysfunction, seven had successful revision of the shunt. None of these seven patients had refractory ascites after revision or died from end-stage liver disease.
Conclusions:
In patients with Budd-Chiari syndrome treated with portosystemic shunting, shunt dysfunction has a major impact on morbidity and mortality.
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