Successful splenorenal shunt occlusion with balloon-occluded retrograde transvenous obliteration yielded improvement of residual liver function, enabled administration of direct-acting antivirals, and achieved sustained virological response to hepatitis C virus: A case report
| Autor: | Shunji Takechi, Kouji Joko, Toshie Mashiba, Hironori Ochi, Michiko Aono, Tomoyuki Yokota |
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| Rok vydání: | 2016 |
| Předmět: |
medicine.medical_specialty
Cirrhosis Daclatasvir Combination therapy Sustained Virologic Response Hepacivirus Esophageal and Gastric Varices Gastroenterology Antiviral Agents 030218 nuclear medicine & medical imaging 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Internal medicine medicine Humans Hepatic encephalopathy Aged business.industry Balloon Occlusion medicine.disease Combined Modality Therapy Hepatitis C digestive system diseases Surgery chemistry Liver Hepatocellular carcinoma Asunaprevir 030211 gastroenterology & hepatology Female Liver function Portosystemic shunt business Splenorenal Shunt Surgical medicine.drug |
| Zdroj: | Journal of digestive diseases. 18(2) |
| ISSN: | 1751-2980 |
| Popis: | We report the use of balloon-occluded retrograde transvenous obliteration (BRTO) for portosystemic shunt in one patient, resulting in marked improvements in residual liver function and enabling safe hepatitis C virus (HCV) elimination with direct-acting antiviral agents. A woman undergoing outpatient treatment at our institution for HCV-related cirrhosis with a history of hepatocellular carcinoma (HCC) treatment developed hepatic encephalopathy (HE; Child-Pugh score 8) at age 65 years. Improvement was obtained with conservative treatment; however, contrast-enhanced computed tomography revealed a splenorenal shunt with decreased portal vein blood flow. Therefore, BRTO was performed to prevent HE recurrence, to improve liver function, and to enable administration of direct-acting antivirals. Postoperatively, marked reduction of the shunt flow was confirmed, and the Child-Pugh score improved from 8 to 5. Subsequent recurrence of HCC was treated with local therapy, after which combination therapy with asunaprevir and daclatasvir was performed, achieving sustained virologic response 24 weeks after completion. No subsequent recurrence of HCC or HE has been observed to date. Copyright © 2017 John Wiley & Sons, Ltd. |
| Databáze: | OpenAIRE |
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