Living Donor Liver Transplant for Budd-Chiari Syndrome Without Caval Replacement: A Single-Center Study

Pandey, Yuktansh; Vijayashanker, Aarathi; Chikkala, Bhargava Ram; Acharya, M Rajgopal; Bashir, Shazia; Dey, Rajesh; Agarwal, Shaleen; Gupta, Subhash

doi:10.6002/ect.2020.0541

Cited by 2 publications

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“…These data are consistent with prior studies showing that LT yields positive long-term outcomes in BCS patients. 12 , 21 , 23 Since the start of the MELD-era organ allocation system, outcomes for BCS patients have markedly improved, with a 3‐y posttransplant survival of 84%. 9 Similarly, in another study, overall survival was 76%, 71%, and 68% at 1, 5, and 10 y, respectively.…”

Section: Discussionmentioning

confidence: 99%

Liver Transplantation for Budd-Chiari Syndrome in the MELD Era

Alqahtani

Schneider

Sims

et al. 2022

Transplantation Direct

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Liver TransplantationBackground. To evaluate clinical characteristics and factors associated with survival among liver transplantation (LT) recipients with Budd-Chiari syndrome (BCS), with or without transjugular intrahepatic portosystemic shunt (TIPS), in the post-Model for End-stage Liver Disease era. Methods. We extracted data from the United Network for Organ Sharing database on all adult (≥18 y old) waitlisted candidates and recipients of LT with BCS in the United States between 2002 and 2019. Multivariable Cox regression was used to determine predictors of mortality and hazard ratios (HRs). Results. A total of 647 BCS patients were waitlisted between 2002 and 2019. BCS was an indication for LT in 378 (0.2%) of all adult LT recipients during the study period. Of BCS patients who received LT, approximately three-fourths (72.3%) were alive for up to 10 y. We found no significant difference in LT outcomes in BCS patients with or without TIPS. Longer length of hospital stay following LT (HR, 1.32; 95% confidence interval [CI], 1.19-1.47), Black/African American race (HR, 2.24; 95% CI, 1.38-3.64), diabetes (HR, 3.17; 95% CI, 1.62-6.21), donor risk index (HR, 1.44; 95% CI, 1.05-1.99), and lower albumin levels at the time of transplantation (HR, 0.66; 95% CI, 0.50-0.88) were negatively associated with survival after LT. Interestingly, neither the Model for End-stage Liver Disease nor prior TIPS showed a significant association with survival after LT. Conclusions. These findings demonstrate good comparable survival among TIPS versus no TIPS in LT recipients with BCS. The decision for TIPS versus LT should be individualized on a case-by-case basis.

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Section: Discussionmentioning

confidence: 99%

Liver Transplantation for Budd-Chiari Syndrome in the MELD Era

Alqahtani

Schneider

Sims

et al. 2022

Transplantation Direct

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Effect of TIPS insertion on waitlist mortality and access to liver transplantation in Budd-Chiari syndrome

Akabane,

Imaoka,

Nakayama

et al. 2024

Liver Transplantation

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Background: The impact of transjugular intrahepatic portosystemic shunt (TIPS) on waitlist mortality and liver transplantation (LT) urgency in Budd-Chiari Syndrome (BCS) patients remains unclear. Method: We analyzed BCS patients listed for LT in the UNOS database(2002-2024) to assess TIPS’s impact on waitlist mortality and LT access via competing-risk analysis. We compared trends across two phases:Phase1(2002-2011) and Phase2(2012-2024). Results: Of 815 BCS patients, 263(32.3%) received TIPS at listing. TIPS group had lower MELD-Na scores(20vs22,p<0.01), milder ascites(p=0.01), and fewer Status1 patients(those at risk of imminent death while awaiting LT)(2.7%vs8.3%,p<0.01) at listing compared to those without TIPS. TIPS patients had lower LT rates(43.3%vs56.5%,p<0.01) and longer waitlist times(350vs113 d,p<0.01). TIPS use increased in Phase2(64.3%vs35.7%,p<0.01). Of 426 transplanted patients, 134(31.5%) received TIPS, showing lower MELD-Na scores(24vs27,p<0.01) and better medical conditions(Intensive care unit:14.9%vs21.9%,p<0.01) at LT. Status1 patients were fewer (3.7%vs12.3%,p<0.01), with longer waiting days(97vs26 d,p<0.01) in TIPS group. TIPS use at listing increased from Phase1(25.6%) to Phase2(37.7%). From Phase1 to Phase2, ascites severity improved, re-LT cases decreased(Phase1:9.8%vsPhase2:2.2%,p<0.01), and cold ischemic time slightly decreased(Phase1:7.0vsPhase2:6.4 hours,p=0.14). Median donor body mass index significantly increased. No significant differences were identified in patient/graft survival at 1-/5-/10-year intervals between phases or TIPS/non-TIPS patients. While 90-day waitlist mortality showed no significant difference(p=0.11), TIPS trended towards lower mortality(subHazard ratio[sHR]:0.70[0.45-1.08]). Multivariable analysis indicated that TIPS was a significant factor in decreasing mortality(sHR:0.45[0.27-0.77],p<0.01). TIPS group also showed significantly lower LT access(sHR:0.65[0.53-0.81],p<0.01). Multivariable analysis showed that TIPS was a significant factor in decreasing access to LT(sHR:0.60[0.46-0.77],p<0.01). Sub-group analysis excluding Status1 or HCC showed similar trends. Conclusion: TIPS in BCS patients listed for LT reduces waitlist mortality and LT access, supporting its bridging role.

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Living Donor Liver Transplant for Budd-Chiari Syndrome Without Caval Replacement: A Single-Center Study

Cited by 2 publications

References 0 publications

Liver Transplantation for Budd-Chiari Syndrome in the MELD Era

Liver Transplantation for Budd-Chiari Syndrome in the MELD Era

Effect of TIPS insertion on waitlist mortality and access to liver transplantation in Budd-Chiari syndrome

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