Rotterdam score predicts early mortality in Budd-Chiari syndrome, and surgical shunting prolongs transplant-free survival
Article first published online: 1 SEP 2009
© 2009 The Authors. Journal compilation © 2009 Blackwell Publishing Ltd
Alimentary Pharmacology & Therapeutics
Volume 30, Issue 10, pages 1060–1069, November 2009
How to Cite
MONTANO-LOZA, A. J., TANDON, P., KNETEMAN, N., BAILEY, R. and BAIN, V. G. (2009), Rotterdam score predicts early mortality in Budd-Chiari syndrome, and surgical shunting prolongs transplant-free survival. Alimentary Pharmacology & Therapeutics, 30: 1060–1069. doi: 10.1111/j.1365-2036.2009.04134.x
- Issue published online: 20 OCT 2009
- Article first published online: 1 SEP 2009
- Publication data Submitted 15 July 2009 First decision 26 July 2009 Resubmitted 17 August 2009 Accepted 26 August 2009 Epub Accepted Article 26 August 2009
Background Budd–Chiari syndrome carries significant mortality, but factors predicting this outcome are uncertain.
Aim To determine factors associated with 3-month mortality and compare outcomes after surgical shunting or liver transplantation.
Methods From 1985 to 2008, 51 patients with Budd–Chiari syndrome were identified.
Results By logistic regression analysis, features associated with higher risk of 3-month mortality were Rotterdam class III, Clichy >6.6, model for end-stage liver disease (MELD) >20 and Child–Pugh C. Rotterdam class III had the best performance to discriminate 3-month mortality with sensitivity of 0.89 and specificity of 0.63, whereas Clichy >6.60 had sensitivity of 0.78 and specificity of 0.69; MELD >20 had sensitivity of 0.78 and specificity of 0.75 and Child–Pugh C had sensitivity of 0.67 and specificity of 0.72. Eighteen patients underwent surgical shunts and 14 received liver transplantation with no significant differences in survival (median survival 10 ± 3 vs. 8 ± 2 years; log-rank, P = 0.9).
Conclusions Rotterdam score is the best discrimination index for 3-month mortality in Budd–Chiari syndrome and should be used preferentially to determine treatment urgency. Surgical shunts constitute an important therapeutic modality that may help save liver grafts and prolong transplantation-free survival in a selected group of patients with Budd–Chiari syndrome.