Publicaciones científicas
Recent outcomes of liver transplantation for Budd Chiari Syndrome - a study of the European Liver Transplant Registry (ELTR) and affiliated centers
Edo Dongelmans 1 , Nicole Erler 2 , Rene Adam 3 , Silvio Nadalin 4 , Vincent Karam 3 , Sezai Yilmaz 5 , Claire Kelly 6 , Jacques Pirenne 7 , Koray Acarli 8 , Michael Allison 9 , Abdul Hakeem 10 , Dhakshinamoorthy Vijayanand 10 , Dzmitry Fedaruk 11 , Oleg Rummo 11 , Murat Kilic 12 , Arno Nordin 13 , Lutz Fischer 14 , Alessandro Parente 15 , Darius Mirza 15 , William Bennet 16 , Yaman Tokat 17 , Francois Faitot 18 , Barbara B Antonelli 19 , Gabriela Berlakovich 20 , David Patch 21 , Frederik Berrevoet 22 , Marija Ribnikar 23 , Theophile Gerster 24 , Eric Savier 25 , Salvatore Gruttadauria 26 27 , Bo-Göran Ericzon 28 , Andrés Valdivieso 29 , Valentin Cuervas-Mons 30 , Baltasar Perez Saborido 31 , Roland S Croner 32 , Luciano De Carlis 33 , Giulia Magini 34 , Roberta Rossi 35 , Irinel Popescu 36 , Laze Razvan 36 , Stefan Schneeberger 37 , Hans Blokzijl 38 , Laura Llado 39 , Miguel Angel Gomez Bravo 40 , Christophe Duvoux 41 , Vladimír Mezjlík 42 , Gabriel C Oniscu 43 , Kelsey Pearson 43 , Murat Dayangac 44 , Valerio Lucidi 45 , Olivier Detry 46 , Fernando Rotellar 47 , Caroline den Hoed 1 , Wojciech G Polak 48 , Sarwa Darwish Murad 1 ; all other contributing centers (www.eltr.org) for the European Liver and Intestine Transplant Association (ELITA)
Background and aims: Management of Budd-Chiari Syndrome (BCS) has improved over the last decades. The main aim was to evaluate the contemporary post-liver transplant (LT) outcomes in Europe.
Approach and results: Data from all transplanted patients from 1976-2020 was obtained from the European Liver Transplantation Registry (ELTR). Patients<16yrs, with secondary BCS or hepatocellular carcinoma were excluded. Patient- (PS) and graft survival (GS) before and after 2000 were compared. Multivariate Cox regression-analysis identified predictors of PS and GS after 2000. Supplementary data was requested from all ELTR-affiliated centers and received from 44. 808 patients were transplanted between 2000-2020. One-, five- and ten-year PS was 84%, 77% and 68% and GS was 79%, 70% and 62%, respectively. Both significantly improved, compared to outcomes before 2000 (p<0.001). Median follow up was 50 months and re-transplantation rate was 12%. Recipient age (aHR:1.04,95%CI:1.02-1.06) and MELD-score (aHR:1.04,95%CI:1.01-1.06), especially above 30, were associated with worse PS, while male sex had better outcomes (aHR:0.63,95%CI:0.41-0.96). Donor age was associated with worse PS (aHR:1.01,95%CI:1.00-1.03) and GS (aHR:1.02,95%CI:1.01-1.03). In 353 patients (44%) with supplementary data, 33% had myeloproliferative neoplasm, 20% underwent TIPS pre-LT and 85% used anticoagulation post-LT. Post-LT anticoagulation was associated with improved PS (aHR:0.29,95%CI:0.16-0.54) and GS (aHR:0.48,95%CI:0.29-0.81). Hepatic artery thrombosis and portal vein thrombosis occurred in 9% and 7%, while recurrent BCS was rare (3%).
Conclusion: LT for BCS results in excellent patient- and graft survival. Older recipient or donor age, and higher MELD are associated with poorer outcomes, while long-term anticoagulation improves both patient and graft outcomes.
CITA DEL ARTÍCULO Hepatology. 2024 Feb 15. doi: 10.1097/HEP.0000000000000778
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