Budd-Chiari Syndrome Causing Acute Liver Failure: A Multicenter Case Series
| Autor: | Vlad M. Matei, Daniel Friedman, Alejandro Canas-Coto, William M. Lee, Justin R. Parekh |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
Adult
Male medicine.medical_specialty Abdominal pain Time Factors medicine.medical_treatment Biopsy Liver transplantation Budd-Chiari Syndrome Article 03 medical and health sciences Young Adult 0302 clinical medicine Rare Diseases Liver Function Tests Ascites medicine Humans Hospital Mortality Survival rate Transplantation Hepatology business.industry Anticoagulants Ultrasonography Doppler Jaundice Middle Aged Liver Failure Acute medicine.disease Surgery Liver Transplantation Survival Rate Treatment Outcome Liver 030220 oncology & carcinogenesis Budd–Chiari syndrome Prothrombin Time 030211 gastroenterology & hepatology Female medicine.symptom Portasystemic Shunt Transjugular Intrahepatic business Tomography X-Ray Computed Transjugular intrahepatic portosystemic shunt Rare disease Hepatomegaly |
| Popis: | Budd-Chiari syndrome (BCS) is a rare disease resulting from obstruction of the hepatic venous outflow tract that typically presents with abdominal pain, jaundice, and ascites without frank liver failure. However, BCS may also evolve more rapidly to acute liver failure (ALF). In this study, we describe the clinical features, treatment, and outcomes of ALF due to BCS and compare our results with those in the published literature. Twenty of the 2344 patients enrolled in the Acute Liver Failure Study Group (ALFSG) registry since 1998 presented with a clinical diagnosis of BCS. An additional 19 patients of ALF-BCS in the English language literature were reviewed and compared with the ALFSG cases. Most ALF-BCS patients were white (84%) and female (84%) in their fourth decade. A hypercoagulable state was noted in 63% of patients. BCS was diagnosed by Doppler ultrasonography or abdominal computed tomography in all patients. Liver biopsies (n = 6) all had evidence of severe pericentral necrosis. Treatments used included most commonly anticoagulation (71%), but also transjugular intrahepatic portosystemic shunt (TIPS; 37%) and orthotopic liver transplantation (37%). In-hospital mortality was approximately 60%. In conclusion, BCS is a rare cause of ALF and mandates prompt diagnosis and management for successful outcomes. Once the diagnosis is confirmed, prompt anticoagulation is recommended in conjunction with evaluation for malignancy or thrombophilic disorder. Mortality may have improved in recent years with use of TIPS and/or orthotopic liver transplantation compared with prior published reports. Liver Transplantation 23 135-142 2017 AASLD. |
| Databáze: | OpenAIRE |
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