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TEN-YEAR OUTCOMES OF TIPS FOR BUDD-CHIARI SYNDROME: SYSTEMATIC REVIEW AND META-ANALYSIS
Mariana Oliveira Amarante Moreno1, Cláudio Luiz da Silva Lima Paz2, Maria Gabriela Fernandes Dezan1,3,4
1Escola Bahiana de Medicina e Saúde Pública; Salvador, BA, Brasil.
Insights
Transjugular intrahepatic portosystemic shunt (TIPS) effectively treats Budd-Chiari syndrome (BCS), significantly reducing portosystemic pressure and improving long-term survival rates. The procedure demonstrates a low rate of liver transplantation and technical failure in BCS patients.
Area of Science:
- Hepatology
- Interventional Radiology
- Gastroenterology
Background:
- Budd-Chiari syndrome (BCS) involves hepatic venous outflow obstruction, potentially leading to liver cirrhosis.
- Transjugular intrahepatic portosystemic shunt (TIPS) is a potential treatment for a subset of BCS patients.
Purpose of the Study:
- To systematically review and meta-analyze the effectiveness of TIPS in treating BCS.
- To evaluate survival rates, portosystemic pressure reduction, need for liver transplantation, technical failure, and shunt dysfunction up to 10 years post-procedure.
Main Methods:
- A systematic review and meta-analysis of 17 studies involving 618 BCS patients treated with TIPS.
- Data extracted from PubMed, Science Direct, Web of Science, and SCOPUS databases.
- Bias risk assessed using NOS, NHI, and JBI scales; meta-analyses performed using R software.
Main Results:
- A 19% reduction in portosystemic pressure was observed.
- The rates for liver transplantation, technical failure, and shunt dysfunction were 6%, 2%, and 30%, respectively.
- High survival rates were reported: 88% between 1-10 years, 92% at 5 years, and 77% at 10 years.
Conclusions:
- TIPS is an effective treatment for BCS, associated with high long-term survival and significant portosystemic pressure reduction.
- The need for liver transplantation and technical failure rates following TIPS placement for BCS are low.
Background:
Budd-Chiari syndrome (BCS) results from the obstruction of the hepatic venous flow, usually at the level of the hepatic vein or inferior vena cava. When left untreated, it can progress with several complications, including liver cirrhosis. Transjugular intrahepatic portosystemic shunt (TIPS) appears to be effective in a subgroup of BCS patients.
Objective:
To perform a systematic review and meta-analysis of TIPS effectiveness in BCS treatment, considering the survival rate, reduction in portosystemic pressure, need for liver transplantation, technical failure, and shunt dysfunction for up to 10 years of follow-up.
Methods:
We evaluated 17 studies published in PubMed, Science Direct, Web of Science, and SCOPUS databases, which used TIPS as a treatment for BCS, comprising 618 subjects between 18 and 78 years old. We assessed the bias risk by the NOS, NHI, and JBI scales for cohort stu-dies, before-after studies, and case series, respectively. We conducted the meta-analyses by extracting the number of events and the total patients evaluated to perform the proportion meta-analyses using the R software ("meta" package - version 4.9-6).
Results:
The pooled results (95%CI) showed a 19% (25.9-12.5%) rate of portosystemic pressure reduction, 6% (1-12%) rate for the need for liver transplants despite the use of TIPS, 2% (1-6%) technical failure rate, 30% (18-46%) shunt dysfunction rate, and 88% (81-93%) for the mean frequency of patients alive between 1 and 10 years after the procedure. We stratified survival rate and found an 86% (74-93%) prevalence of living subjects during less than five years, 92% (83-97%) at five years, and a 77% frequency (68-83%) of patients alive ten years after the TIPS placement.
Conclusion:
TIPS is an effective treatment for BCS, providing a high 10-year frequency of living patients and a significant decrease in portosystemic pressure. The need for liver transplants after TIPS and the technical failure rate is low.
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