Transjugular intrahepatic portosystemic shunt for the treatment of hepatic sinusoidal obstruction syndrome caused by pyrrolizidine alkaloids: A multicenter retrospective study

Chaoyang Wang; Yingliang Wang; Jianbo Zhao; Chongtu Yang; Xiaoli Zhu; Huanzhang Niu; Junhui Sun; Bin Xiong

doi:10.1016/j.heliyon.2023.e23455

Transjugular intrahepatic portosystemic shunt for the treatment of hepatic sinusoidal obstruction syndrome caused by pyrrolizidine alkaloids: A multicenter retrospective study

Heliyon. 2023 Dec 8;10(1):e23455. doi: 10.1016/j.heliyon.2023.e23455. eCollection 2024 Jan 15.

Authors

Chaoyang Wang^{1

2}, Yingliang Wang^{1

2}, Jianbo Zhao³, Chongtu Yang^{1

2}, Xiaoli Zhu⁴, Huanzhang Niu⁵, Junhui Sun⁶, Bin Xiong^{1

2

7}

Affiliations

¹ Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
² Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China.
³ Department of Vascular and Interventional Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, 510000, China.
⁴ Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, Suzhou, 215000, China.
⁵ Department of Interventional Radiology, The First Affiliated Hospital of Henan University of Science and Technology, Luoyang, 471000, China.
⁶ Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Zhejiang University, Hangzhou, 310000, China.
⁷ Department of Interventional Radiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510000, China.

Abstract

Purpose: To assess the impact of transjugular intrahepatic portosystemic shunt (TIPS) on clinical outcomes and liver histology in patients with hepatic sinusoidal obstruction syndrome (HSOS) caused by pyrrolizidine alkaloids (PA), and compare these results with those of patients who received supportive treatment alone.

Materials and methods: From June 2015 to August 2022, 164 patients diagnosed with PA-HSOS in six tertiary care centers were retrospectively included in this study and divided into TIPS group (n = 69) and supportive treatment (ST) group (n = 95). The main endpoint was to determine whether TIPS placement could improve survival in PA-HSOS patients. The clinical symptoms associated with portal hypertension were also evaluated in this study. Additionally, a small TIPS-subgroup of 7 patients received liver biopsies before and after TIPS for histological analysis.

Results: The incidence of death was markedly lower in the TIPS group than in the ST group (log-rank p = 0.026). Multivariate Cox model revealed that group assignment (hazard ratio (HR) 5.146; 95 % confidence interval (CI) 1.587-16.687; p = 0.006), total bilirubin (HR 1.029; 95 % CI 1.020-1.038; p < 0.001), and INR (HR 13.291; 95 % CI 3.637-48.566; p < 0.001) were independent predictors for mortality. In addition, TIPS placement reduced the risk of complications associated with portal hypertension but did not increase the rate of overt hepatic encephalopathy (log-rank p = 0.731). Furthermore, six of 7 TIPS patients receiving liver biopsies improved after TIPS placement, and one patient developed fibrosis.

Conclusions: TIPS placement decreased the mortality and risk of complications associated with portal hypertension. Histological evaluation in a few patients showed a potential improvement by TIPS.

Keywords: Hepatic sinusoidal obstruction syndrome; Multicenter; Pyrrolizidine alkaloids; Transjugular intrahepatic portosystemic shunt.