Portasystemic Shunting Versus Liver Transplantation for the Budd-Chiari Syndrome

Abstract

Over 12 years, 22 patients with the Budd-Chiari syndrome were treated surgically. Eighteen underwent a mesenterico-caval shunt (MCS); two, a side-to-side portacaval shunt; one, a mesenterico-atrial shunt (MAS); and one, a liver transplantation (OLT). One patient died after operation from the precipitating condition, and two MCS grafts that thrombosed were restored. All 21 surviving patients remain well, free from ascites, and all shunts are patent after a mean follow-up of 5.6 +/- 1 years, five patients with more than 10 years' follow-up. This long-term survival achieved by portasystemic shunts suggests that they have a major role in the treatment of the Budd-Chiari syndrome. The authors prefer the mesenterico-caval shunt using a jugular graft. This ensures a total portasystemic shunt, avoids subhepatic surgery, and reduces the long-term risk of prosthetic graft thrombosis. The MAS was reserved for cases with complete caval thrombosis. Patients with significant degrees of caval compression were satisfactorily decompressed by MCS. In patients not promptly treated, the disease progresses to cirrhosis, and such patients must be evaluated for transplantation similarly to those with other hepatopathies.

Determinants of survival and the effect of portosystemic shunting in patients with Budd-Chiari syndrome

“…Other studies, mostly case series from surgical units, report on high survival rates after PSS with 5-year survival of 57% 11 to 94%. 9,10 However, most of these studies do not provide data on patient selection criteria, which play a major role in the long-term results of treatment, 21 nor do they take account of differences in time-point of shunting within the clinical course of patients.…”

Changing spectrum of Budd-Chiari syndrome in India with special reference to non-surgical treatment

“…Few reports have shown the beneficial results of surgery in selected BCS patients with low operative mortality up to 5%, high long-term assisted patency rate of more than 90% and five-year survival rates more than 75% [2,[69][70][71][72] . Poor results of surgery in patients with liver dysfunction; anatomical difficulties causing success rates as low as 30%; higher post-operative complications and mortality rates (more than 20%); high re-stenosis rates (around 30%) requiring surgical revisions in a minority (around 10%); and poor survival rates as low as 57% at five years have been described [1,3,4,70,73,74] .…”

Budd-chiari syndrome in patients with hematological disease: A therapeutic challenge

“…Patients with cirrhosis on biopsy, or significantly impaired liver function, or patients with acute BCS who have failed shunt therapy are candidates for OLT. 5,21,23,26 There were several problems in our patient that made management a clinical challenge. Because data on management of BCS in patients with hematological disease are very limited, we discuss issues that treating physicians might find useful the next time they deal with such patients.…”