Transjugular intrahepatic portosystemic shunt for hepatic sinusoidal obstruction syndrome induced by pyrrolizidine alkaloid.

PURPOSE: To evaluate the efficacy and outcomes of transjugular intrahepatic portosystemic shunt (TIPS) in treating pyrrolizidine alkaloid-induced hepatic sinusoidal obstruction syndrome (PA-HSOS).

METHODS

We conducted a retrospective analysis of patients diagnosed with severe PA-HSOS at our institution between January 2016 and October 2025. Baseline clinical characteristics and follow-up data were extracted from medical records. All included patients had failed prior conventional medical therapy.

RESULTS

A total of 125 patients diagnosed with HSOS was screened and 33 patients ultimately included in this study, of whom 17 were male. Clinical presentations comprised ascites in 31 patients, and variceal bleeding in 2 patients. During a median follow-up of 42 months (ranging from 2 to 118 months), there were four deaths, only one related to liver failure. The overall survival rates at 1, 3 and 5 years were 93.8%, 90.3% and 82.1%, respectively. Clinical improvement was observed in most patients, with ascites resolving in 31 patients one month after the procedure, and the hepatic vein was clearly displayed on post-TIPS imaging in 26 patients, confirming successful shunt patency. Notably, no cases of overt hepatic encephalopathy were observed during the follow-up period.

CONCLUSION

TIPS is associated with favorable clinical and survival outcomes in patients with PA-HSOS refractory to medical management, and represents a viable therapeutic alternative for this condition.