Background/purpose: The etiology of portal hypertension may be an important factor affecting patient outcomes after transjugular intrahepatic portosystemic shunt (TIPS) treatment. Pyrrolizidine alkaloid-induced hepatic sinusoidal obstruction syndrome (PA-HSOS) is characterized by acute portal hypertension and liver injury. The aim of this study was to compare the post-TIPS survival between patients with PA-HSOS and those with other etiologies of hepatic portal hypertension.
Methods: A retrospective file review of 787 patients with portal hypertension-related complications, including 146 patients with PA-HSOS, who had received TIPS treatment at our institution between August 2008 to September 2020 was performed. We recorded the demographic and clinical characteristics of patients before TIPS. The median follow-up was 20.27 months. Orthotopic liver transplantation (OLT)-free survival was compared between PA-HSOS and non-HSOS patients. Propensity score matching (PSM) was used to minimize bias.
Results: Compared to patients with other etiologies of portal hypertension, PA-HSOS patients had a statistically significantly higher Child-Pugh and model for end-stage liver disease score. No significant differences were found in the orthotopic liver transplantation (OLT)-free survival between patients with PA-HSOS and patients with other causes of portal hypertension (all P > 0.05). After PSM, OLT-free survival was significantly better in PA-HSOS patients than in patients with viral hepatitis (P = 0.0011), primary biliary cirrhosis or autoimmune hepatitis (P = 0.021), and schistosomiasis (P = 0.025).
Conclusions: TIPS placement can be performed safely in patients with PA-HSOS. PA-HSOS patients had a better or similar prognosis after TIPS treatment than patients with portal hypertension of other etiologies.
Trial registration: This study was retrospectively registered in the chictr.Org database (ChiCTR2000040899) in 14 December 2020.