Outcome of Transjugular Intrahepatic Portosystemic Shunt (TIPS) in Budd-Chiari Syndrome patients Single centre experience

Abstract

Summary T he aim of the current study was to determine short term and Long term outcome of TIPS among patients with BCS. To reach our aim, 121patients were included in this study with confirmed diagnosis of BCS and eligible criteria for radiological intervention. Follow up after intervention was at least for 1 year and at the end of the study; with a range of follow up from 1-5 years. Results of the current study showed that BCS is common among young persons with a mean age of 28.75 ± 8.55 (range 11-47) years and more predominant in females than males (64.5% versus 35.5% respectively) with MTHFER gene mutation is the leading cause. According to Child-Pugh score, 29 patients (23.9%) were Child A, 68 patients (56.19%) were Child B and 24 patients (19.8%) were Child C. According to Rotterdam classification, 54 patients (44.6%) were class I, 36 patients (29.7%) were class II and 31 patients (29.7%) were class I I I. According to BCS-TIPS score, all our patients had score less than 7. Regarding the short term outcome; related frequency of procedure complications were as follows: sepsis (14%), intraperitoneal bleeding (12.39%) and hepatic encephalopathy (1.6%). Ascites and abdominal pain significantly decreased. Also events of hepatic encephalopathy and GIT Bleeding also declined, however, insignificantly. Regarding the effect of TIPS on liver profile, there was significant increase in Albumin and reduction in Bilirubin levels post TIPS. As regards shunt patency in the first year after TIPS, it was 70.19%. 29.81%(31 patients) needed re-intervention in the form of angioplasty (25 patients), angioplasty with stenting in 4 patients and re-TIPS in 2 patients. Regarding theLong term outcome,we found that most of the cases 86.5% were kept compensated (absent signs of decompensation) but some complications occurred especially in patients with occluded stents as hepatic encephalopathy in 5 patients (4.8%), hematemesis in 2 patients (1.9%)and also ascites in 2 patients (1.9%). Mortality rate was 4.8% (5 patients). The cause of death was acute liver cell failure in 2 patients, Upper GIT bleeding (Hematemesis – melena) in 2 patients and infection in 1 patient. As regards shunt patency in long term follow up in the current study it was 76.77% and 23.2% (23 patients) needed re-intervention (11 cases for once and 12 for twice or more). The pattern of re-intervention was angioplasty in 18 patients and angioplasty with stenting in 3 patients and reTIPS in 2patients. 10 patients were occluded in early follow up and continued to be occluded (inspite of re-intervention) during late follow up inspite of proper anticoagulation. The Impact of TIPS on Child Pugh and MELD scores, Both Child Pugh and MELD scores were significantly improved following TIPS. The 1, 3, 5 year orthotopic liver transplantation(OLT) free survival rate of the studied patients were 85.9%,83.47%,81,8% respectively. There was no significant association between survival and child pugh and MELD score pre and post TIPS.