2952 Liver Transplant in Patients With Budd-Chiari Syndrome: A National Study

Abstract

INTRODUCTION: Budd-Chiari syndrome (BCS) involves obstruction of hepatic venous outflow tracts at various levels from small hepatic veins to the inferior vena cava and is the result of thrombosis or its fibrous sequelae. The clinical presentation and clinical manifestations are so varied that it should be suspected in any patient with acute or chronic liver dysfunction. Liver transplantation (LT) may be indicated as a rescue treatment or for fulminant cases with promising results. Living donor liver transplantation (LDLT) can also be used for patients with BCS if deceased donor livers are scarce. The Aim of this study is to assess the mortality rate and review the safety of liver transplant in patients with Budd-Chiari Syndrome. METHODS: The National Inpatient Sample (NIS) is the largest all-payer inpatient database consisting of approximately 20% of all inpatient admissions to nonfederal hospitals in the United States. We collected and reviewed data records of new liver transplant patients from the NIS database from the year 2009 to 2014. IBM Statistical Package for the Social Sciences (SPSS) version 25 was used for statistical analysis. RESULTS: A total of 5,592 patients were discharged between 2009-2014 with a new liver transplant. Of these patients, there were 37 patients (0.66%) with BCS. The overall mortality rate for a new liver transplant was substantially higher for BCS patients (10.8%) when compared to non-BCS patients (4.0%) with an odds ratio (OR) of 2.92 (CI 1.03-8.32). However, liver transplant complications were not significantly higher in BCS patients (27.0%) when compared with non-BCS patients (15.3%) with OR of 2.06 (CI 0.99-4.26). The mean length of stay was higher in BCS patients at 32 days as compared to non-BCS patients at 20 days (P = 0.001). Results of the statistical analysis are presented in Tables 1 and 2. CONCLUSION: LT can be indicated as a rescue treatment or for fulminant cases with promising results. LDLT can also be used for patients with BCS, but it involves a difficult procedure particularly regarding venous outflow reconstruction. Our research indicates that liver transplant is riskier in patients with BCS and we encourage more research to be done regarding BCS patients regarding liver transplantation. Limitations of the study are that the NIS is an administrative database which predisposes to errors from coding inaccuracies as well as the inability to distinguish temporal relationships between variables. Future prospective studies can expand on these conclusions.