Difference in Budd-Chiari syndrome between the West and China.

Abstract

Potential conflict of interest: Nothing to report. Author names in bold designate shared co‐first authorship. To the Editor: We read with great interest the review by Wang and colleagues1 that comprehensively analyzed the similarity and discrepancy in the epidemiology and characteristics of liver diseases between China and Western countries. Several common liver diseases were discussed, such as viral hepatitis, alcoholic liver disease, nonalcoholic fatty liver diseases, liver cirrhosis, and hepatocellular carcinoma. Herein, we express additional concern about Budd‐Chiari syndrome (BCS) which is a vascular liver disease resulting in life‐threatening liver failure and portal hypertension–related complications.2 The sites of occlusion, clinical presentations, etiological distributions, and preferred treatment modalities of BCS may be different between Western and Chinese populations. First, the occlusion is often located at the hepatic veins in the West. By comparison, a combined occlusion of hepatic vein and inferior vena cava is the most frequent type of BCS in China. Second, most Western patients have a rapid disease course with progressive hepatic function impairment due to acute thrombosis within the hepatic veins. However, a majority of Chinese patients have a relatively long history of abdominal wall varices and lower limb edema due to chronic occlusion of the inferior vena cava.3 Third, approximately 80% of Western patients have at least one thrombotic risk factor,4 such as myeloproliferative neoplasms with or without JAK2 V617F mutation, factor V Leiden mutation, prothrombin G20210A mutation, and paroxysmal nocturnal hemoglobinuria. In contrast, these are less frequently observed in Chinese patients.5 Fourth, anticoagulation and transjugular intrahepatic portosystemic shunt are the mainstay treatment options for Western patients. On the contrary, our recent survey of 23,352 Chinese BCS patients suggests that percutaneous recanalization is the most common treatment modality.7 This is because percutaneous recanalization alone can achieve an excellent long‐term patency and survival in most Chinese BCS patients. Collectively, the difference in the characteristics of BCS between the West and China should be clearly recognized by Chinese hepatologists.