Direct Intrahepatic Portocaval Shunt for Sinusoidal Obstruction Syndrome Associated with Hepatotoxicity of Pyrrolizidine Alkaloids

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 alk...

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Bibliographic Details
Published in:BioMed research international 2018-01, Vol.2018 (2018), p.1-8
Main Authors: Yao, Kechun, Huang, He, Chu, Jianguo, Luo, ShiHua
Format: Article
Language:English
Subjects:
Adult
Age
Alanine
Alkaloids
Ascites
Aspartate
Bilirubin
Biopsy
Bleeding
Bone marrow
Care and treatment
Chemical and Drug Induced Liver Injury
China
Cirrhosis
Esophageal and Gastric Varices
Female
Gastrointestinal Hemorrhage
Gynura segetum
Health aspects
Heart failure
Hemorrhage
Hepatic encephalopathy
Hepatic Veno-Occlusive Disease - chemically induced
Hepatic Veno-Occlusive Disease - therapy
Hepatitis
Hepatotoxicity
Herbal medicine
Humans
Hypertension
Laboratories
Liver cirrhosis
Liver diseases
Male
Medical imaging
Middle Aged
Mortality
NMR
Nuclear magnetic resonance
Patients
Portasystemic Shunt, Transjugular Intrahepatic
Pyrrolizidine alkaloids
Pyrrolizidine Alkaloids - adverse effects
Retrospective Studies
Stem cells
Stent (Surgery)
Stents
Surgery
Systematic review
Treatment Outcome
Veins & arteries
Young Adult
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Summary: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.
ISSN:2314-6133
2314-6141
DOI:10.1155/2018/9804582