[en] [en] 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.
Disciplines :
Surgery Gastroenterology & hepatology
Author, co-author :
Dongelmans, Edo; Erasmus MC Transplant Institute, Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
Erler, Nicole; Department of Biostatistics, Erasmus University Medical Center, Rotterdam, The Netherlands
Adam, Rene; Department of Hepato-Biliary Surgery, Cancer and Transplantation unit, Hospital Paul Brousse, Villejuif, France
Nadalin, Silvio; Department of General, Visceral and Transplant Surgery, Universitätsklinik Tübingen, Tubingen, Germany
Karam, Vincent; Department of Hepato-Biliary Surgery, Cancer and Transplantation unit, Hospital Paul Brousse, Villejuif, France
Yilmaz, Sezai; Department of Surgery, Liver Transplant Institute, Turgut Özal Medical Center, Malatya, Turkey
Kelly, Claire; Institute of Liver Studies, King's College Hospital, London, UK
Pirenne, Jacques; Department of Abdominal Transplant Surgery, Universitaire Ziekenhuizen Leuven, Belgium
Acarli, Koray; Department of Liver and Biliary Tract Surgery, Memorial Hospital, Istanbul, Turkey
Allison, Michael; Liver Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge NIHR Biomedical Research Center, Cambridge, UK
Hakeem, Abdul; Department of HPB Surgery and Liver Transplantation, Leeds Teaching Hospitals NHS Trust, Leeds, UK
Vijayanand, Dhakshinamoorthy; Department of HPB Surgery and Liver Transplantation, Leeds Teaching Hospitals NHS Trust, Leeds, UK
Fedaruk, Dzmitry; Department of Transplantation, Minsk Scientific and practical center for surgery, transplantology and hepatology, Minsk, Belarus
Rummo, Oleg; Department of Transplantation, Minsk Scientific and practical center for surgery, transplantology and hepatology, Minsk, Belarus
Kilic, Murat; Department of Surgery, Kent Hospital, Izmir, Turkey
Nordin, Arno; Transplantation and Liver Surgery Unit, Helsinki University Hospital, Helsinki, Finland
Fischer, Lutz; Department of Surgery, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
Parente, Alessandro; Liver Unit, Queen Elizabeth Hospital, Birmingham, UK
Mirza, Darius; Liver Unit, Queen Elizabeth Hospital, Birmingham, UK
Bennet, William; Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
Tokat, Yaman; Department of General Surgery, International Liver Center and Acibadem Health Care Hospitals, Istanbul, Turkey
Faitot, Francois; Department of HPB Surgery and Transplantation, C.H.R.U. de Strasbourg, Strasbourg, France
Antonelli, Barbara B; General and Liver Transplant Surgery Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
Berlakovich, Gabriela; Department of Transplantation Surgery, Medical University of Vienna, Wien, Austria
Patch, David; Department of Hepatology and Liver Transplantation, Royal Free Hospital, London, UK
Berrevoet, Frederik; Department of General and HPB Surgery and Liver Transplantation, University Hospital Gent, Ghent, Belgium
Ribnikar, Marija; Department of Gastroenterology, University Medical Center Lubljana, Ljubljana, Slovenia
Gerster, Theophile; Department of Gastroenterology and Hepatology, C.H.U. de Grenoble, Grenoble, France
Savier, Eric; Department of Digestive Surgery and Liver Transplantation, Pitie Salpetriere university hospital, Sorbonne University, Paris, France
Gruttadauria, Salvatore; Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto di Ricovero e Cura a Carattere Scientifico-Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), UPMC (University of Pittsburgh Medical Center), Palermo, Italy ; Department of Surgery and Medical and Surgical Specialties, University of Catania, Catania, Italy
Ericzon, Bo-Göran; Department of Transplantation Surgery, Karolinska University Hospital, Huddinge, Sweden
Valdivieso, Andrés; Department of HBP Surgery and Liver Transplantation, Cruces University hospital, Bilbao, Spain
Cuervas-Mons, Valentin; Department of Medicine, Hospital Universitario Puerta de Hierro, Madrid, Spain
Saborido, Baltasar Perez; Department of General and Digestive Surgery, Hospital Universitario "Rio Hortega", Valladolid, Spain
Croner, Roland S; Department of General-, Visceral-, Vascular- and Transplant Surgery, University Hospital Magdeburg, Germany
De Carlis, Luciano; Department of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, University of Milano-Bicocca, Milan, Italy
Magini, Giulia; Department of Surgery, Hôpital Universitaire de Genève, Geneve, Switzerland
Rossi, Roberta; Department of Gastroenterology and Transplantation, Università Politecnica delle Marche, Ancona, Italy
Popescu, Irinel; Department of Surgery, University of Medicine "Carol Davila", Bucharest, Romania
Razvan, Laze; Department of Surgery, University of Medicine "Carol Davila", Bucharest, Romania
Schneeberger, Stefan; Department of Visceral, Transplant and Thoracic Surgery, University Hospital, Innsbruck, Austria
Blokzijl, Hans; Department of Gastroenterology and Hepatology, University Medical Center Groningen, Groningen, the Netherlands
Llado, Laura; Department of Surgery, Hospital Universitari de Bellvitge, Barcelona, Spain
Gomez Bravo, Miguel Angel; Department of HPB surgery and Transplantation, Hospital Virgen del Rocio, Sevilla, Spain
Duvoux, Christophe; Department of Medical Liver Transplant Unit and Liver, Hôpital Henri Mondor, Creteil, France
Mezjlík, Vladimír; Department of Transplantation, Center of cardiovascular surgery and transplantations, Brno, Czech Republic
Oniscu, Gabriel C; Edinburgh Transplant Center, Royal Infirmary of Edinburgh, Edinburg, UK
Pearson, Kelsey; Edinburgh Transplant Center, Royal Infirmary of Edinburgh, Edinburg, UK
Dayangac, Murat; Center for Organ Transplantation, Medipol University Hospital, Istanbul, Turkey
Lucidi, Valerio; Department of abdominal surgery, Unit of Hepato-biliary surgery and Liver Transplantation, Hôpital Erasme, Cliniques Universitaires de Bruxelles, Brussels, Belgium
Detry, Olivier ; Centre Hospitalier Universitaire de Liège - CHU > > Service de chirurgie abdo, sénologique, endocrine et de transplantation
Rotellar, Fernando; Department of General and Digestive Surgery, Clinica Universitaria de Navarra, Pamplona, Spain
den Hoed, Caroline; Erasmus MC Transplant Institute, Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
Polak, Wojciech G; Erasmus MC Transplant Institute, Department of Surgery, Division of HPB and Transplant Surgery, Erasmus MC University Medical Center, Rotterdam, the Netherlands
Darwish Murad, Sarwa; Erasmus MC Transplant Institute, Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
all other contributing centers (www.eltr.org) for the European Liver and Intestine Transplant Association (ELITA)
