Garcia-Pagán JC, Heydtmann M, Raffa S et al.; Budd–Chiari Syndrome-Transjugular Intrahepatic Portosystemic Shunt Group.
IDIBAPS and CIBERehd, Barcelona, Spain.
Gastroenterology 2008;135:808–15.
Editor’s note: This was a prospective study conducted over a 12-year period that evaluated the outcomes of 124 patients diagnosed with Budd–Chiari syndrome (BCS) who were treated consecutively with transjugular intrahepatic stent shunt (TIPS). Patients had a 1- and 5-year liver transplant-free survival rate of 88% and 78%, respectively. These good survival rates were particularly striking in those patients who had poor prognostic scores estimated using the Rotterdam BCS index (
Hepatology 2004;39:500–8), which was previously considered to be a robust index. Those with a poor prognosis in the present study had a 5-year, liver transplant-free survival rate of 71% compared with a rate of 42% as estimated by the Rotterdam BCS index. Perhaps not unexpectedly in this study, bilirubin, age, and internationalized normalized ratio (INR) were found to be independently associated with 1-year survival without transplantation. This allowed the authors to derive a more up-to-date index, such that a score >7 was discriminatory between those who went on to have transplantation (seven of eight) versus those who did not (only five of the 114 whose score was ≤7 underwent transplantation).