Abstract
We retrospectively identified 89 consecutive patients from January 2004 to January 2012 to investigate efficacy of direct intrahepatic portocaval shunt (DIPS) combined with inferior vena cava (IVC) stenting for sinusoidal obstruction syndrome (SOS) associated with hepatotoxicity of pyrrolizidine alkaloids. Indications for treatment were variceal hemorrhage and/or refractory ascites. Patients were treated with DIPS plus IVC stenting (group A, n=68) or DIPS alone (group B, n=21). A technical success rate of 100% was obtained in all 89 patients, and there were no early procedure-related adverse events or 30-day mortality. Mean portosystemic gradient decreased in both groups. Changes in aspartate and alanine aminotransferases and total bilirubin did not differ between the groups. Ascites disappeared in group A but was not obvious in group B until IVC stenting. During follow-up, recurrent bleeding and ascites and incidence of hepatic encephalopathy did not differ between the groups. The 1-, 3-, and 5-year survival rate was 98, 89.59, and 80%, respectively. Satisfactory clinical results were obtained for combined DIPS and IVC stenting for SOS associated with pyrrolizidine-alkaloid-related decompensated cirrhosis.
Highlights
Sinusoidal obstruction syndrome (SOS) is a rare vascular disease of the liver, which can lead to lethal liver failure and portal-hypertension-related complications [1]
The clinical syndrome is characterized [2] by hepatomegaly, ascites, weight gain, increased aminotransferase levels, and jaundice due to sinusoidal congestion, which can be caused by alkaloid ingestion [3], hematopoietic stem cell transplantation (HSCT) [4], bone marrow transplantation, and radiationinduced liver disease or chemotherapy, and it is seen after solid organ transplantation [5]
Our results provide evidence that direct intrahepatic portocaval shunt (DIPS) combined with inferior vena cava (IVC) stenting can be performed safely and achieve good clinical results and survival rates in patients with SOS-related to botanical hepatotoxicity
Summary
Sinusoidal obstruction syndrome (SOS) is a rare vascular disease of the liver, which can lead to lethal liver failure and portal-hypertension-related complications [1]. The clinical syndrome is characterized [2] by hepatomegaly, ascites, weight gain, increased aminotransferase levels, and jaundice due to sinusoidal congestion, which can be caused by alkaloid ingestion [3], hematopoietic stem cell transplantation (HSCT) [4], bone marrow transplantation, and radiationinduced liver disease or chemotherapy, and it is seen after solid organ transplantation [5]. Several case reports show the beneficial effects of TIPS in SOS [8]. It improved ascites and lowered the levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT), but not serum total bilirubin (TB) levels. TIPS in SOS does reduce ascites, there is no survival benefit; SOS is not considered an appropriate indication for TIPS [10]
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