Albumin-Bilirubin and Severity as Key Factors of Recovery in Patients With PA-HSOS Undergoing Transjugular Intrahepatic Portosystemic Shunt.

AIM: To evaluate the safety and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) in the management of pyrrolizidine alkaloid-related hepatic sinusoidal obstruction syndrome (PA-HSOS) and to identify key factors influencing the recovery of liver imaging manifestation after TIPS procedure in PA-HSOS patients.

METHODS

A retrospective review was conducted of 30 PA-HSOS patients who received TIPS at Jinhua Municipal Central Hospital between 1 January 2018, and 30 September 2021, following failure of anticoagulation-based comprehensive treatments. Baseline characteristics and follow-up data were collected, including clinical manifestations, laboratory test results, computed tomography (CT) radiological manifestations of the liver, hepatic venous pressure gradient (HVPG), survival, and complications. Laboratory tests before and after TIPS were compared, and multiple linear regression was used to analyze factors associated with the recovery time of liver CT radiological manifestations.

RESULTS

TIPS was successfully performed in all 30 patients, with no procedure-related adverse events. All patients survived the follow-up period. The portal pressure gradient (PPG) significantly reduced from 22.65 ± 6.36 mmHg to 9.40 ± 3.38 mmHg (p < 0.001). The median time to complete ascites remission was 52 days (range: 29-161 days). The median recovery time for liver CT radiological manifestations was 196.5 days (range: 165-229 days). Disease severity and albumin-bilirubin (ALBI) grade were significant factors influencing the recovery time of liver CT radiological manifestations (R2 = 0.666, p = 0.007). Patients with ALBI grade 2 had a significantly shorter recovery time of liver CT radiological manifestations compared to those with ALBI grade 3 (170.44 ± 50.56 days vs 224.83 ± 46.67 days, p = 0.006). Similarly, patients with severe or very severe disease had longer recovery times than those with mild or moderate diseases (218.25 ± 41.60 days vs 162.43 ± 55.11 days, p = 0.004).

CONCLUSIONS

TIPS is a safe and effective treatment for PA-HSOS. Disease severity and ALBI grade are key factors in estimating the recovery time of liver CT radiological manifestations in patients with PA-HSOS.