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Hepatic venous outflow tract obstruction: treatment outcomes and development of a new prognostic score
1Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
Insights
Endovascular therapy for hepatic venous outflow tract obstruction (HVOTO) shows high success rates. A new AIIMS score better predicts survival than existing models, aiding in managing this liver condition.
Area of Science:
- Hepatology
- Interventional Radiology
- Vascular Medicine
Background:
- Hepatic venous outflow tract obstruction (HVOTO) outcomes from endovascular interventions require further validation.
- Limited studies exist on treatment outcomes and prognostic scores for HVOTO.
Purpose of the Study:
- To evaluate treatment outcomes of endovascular interventions for HVOTO in an Indian population.
- To assess the efficacy of prognostic scores in predicting survival for HVOTO patients.
Main Methods:
- A consecutive series of HVOTO patients at a tertiary center were analyzed.
- Technical success and clinical response to endovascular therapy were documented.
- A novel prognostic score (AIIMS HVOTO score) was developed and compared with established scores (Child-Turcotte-Pugh, MELD, Rotterdam PI, BCS-TIPSS PI).
Main Results:
- 70% of 334 patients underwent endovascular therapy with 90% technical success.
- Complete clinical response was observed in 71.2% of patients.
- The AIIMS HVOTO score demonstrated superior performance in predicting 5-year survival compared to other indices.
Conclusions:
- Advanced Child class and lack of response to intervention are linked to poorer outcomes in HVOTO.
- The AIIMS HVOTO score is a more accurate predictor of survival for HVOTO patients.
- Endovascular angioplasty/stenting is effective for most HVOTO cases, often avoiding TIPSS.
Background:
Results of endovascular interventions in hepatic venous outflow tract obstruction (HVOTO) have been reported from limited studies. Treatment outcomes and prognostic scores need further validation.
Aim:
To evaluate treatment outcomes and prognostic scores for hepatic venous outflow tract obstruction in an Indian population.
Methods:
Consecutive patients with hepatic venous outflow tract obstruction diagnosed at a tertiary centre were included. Technical success and clinical response after endovascular interventional therapy were documented. Predictors of survival were assessed with Cox-proportional model. A new score was derived from the factors significant on multivariate analysis and compared with Child-Turcotte-Pugh, model for end-stage liver disease (MELD), Rotterdam prognostic index (PI) and Budd-Chiari syndrome-transjugular intrahepatic portosystemic shunt ( BCS-TIPSS) PI.
Results:
Three hundred and thirty-four patients (56.6% males), median age 24 (3-62) years were included. Hepatic vein was the commonest site of block-isolated hepatic vonous block in 48%, combined hepatic venous-inferior vena cava block in 46%. Endovascular interventional therapy was performed in 233/334 (70%) with 90% technical success. Clinical response was complete in 166 (71.2%), partial in 58 (24.9%) and no response in nine (3.9%). Majority of cases with HV block did not require TIPSS and could be treated with angioplasty (with/without stenting). On Cox-proportional multivariate analysis, Child class C and response to intervention were independent predictors of outcome and used to derive the All India Institute of Medical Sciences (AIIMS) hepatic venous outflow tract obstruction score. The 5-year survival was 92% (95% CI, 81-97%) for score ≤3, 79% (95%CI, 63-88%) for score >3 and ≤4, and 39% (95% CI, 21-57%) for score >4. The performance of AIIMS hepatic venous outflow obstruction score was superior to other prognostic indices.
Conclusions:
Advanced Child class and no response to intervention are associated with poor outcomes. The All India Institute of Medical Sciences hepatic venous outflow tract obstruction score predicts survival better than other prognostic scores.
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