Balloon-Occluded Retrograde Transvenous Obliteration (BRTO) for the Treatment of Medically Refractory Hepatic Encephalopathy (HE) in Patients with ESLD and Significant Portal-Venous Shunting
Liver and Pancreas Transplantation, Dumont-UCLA Liver Transplant Center, Los Angeles, CA.
Meeting: 2018 American Transplant Congress
Abstract number: 470
Keywords: Angiography, Liver cirrhosis, Portal veins
Session Information
Session Name: Concurrent Session: Liver: MELD, Allocation and Donor Issues - 2
Session Type: Concurrent Session
Date: Tuesday, June 5, 2018
Session Time: 2:30pm-4:00pm
Presentation Time: 3:18pm-3:30pm
Location: Room 6B
Background: Patients with medical refractory HE represent a challenging group of patients. Plagued by repeated hospitalizations, long lengths of stay (LOS) and high healthcare costs, often these challenges are not reflected in the current organ allocation system. Refractory HE can be managed by obliteration of portosystemic shunts but the safety and effects of these procedures remain to be defined.
Methods: 10 patients with ESLD and significant portosystemic shunting underwent BRTO. LOS and number of admissions in the 6 months before BRTO were noted. MELD score and components were measured immediately prior to the procedure and at 1, 3, 7, and 10 days post-procedure.
Results:
Patients undergoing BRTO had been admitted to our hospital 3.9±3.0 times for a cumulative LOS of 48.8±31.5 days in the 6 months pre-procedure (table 1). MELD scores immediately pre-BRTO, and 1-, 3-, 7-, and 10- days post BRTO were 27.8±5.6, 27.9±5.6, 27.9±5.3, 28.8±6.7, 32.1±6.8 respectively. BRTO was followed by an increase in MELD and total bilirubin (table 2). There were no reported cases of significant GI bleeding after BRTO prior to definitive treatment with liver transplant.
Table 1. Hospitalizations and length of stay in 6 months before BRTO.
| Patient | Hospitalizations in 6 months before BRTO | hospital days in prior 6 months before BRTO |
| 1 | 3 | 56 |
| 2 | 6 | 113 |
| 3 | 7 | 67 |
| 4 | 9 | 65 |
| 5 | 4 | 58 |
| 6 | 1 | 20 |
| 7 | 0 | 0 |
| 8 | 2 | 20 |
| 9 | 6 | 46 |
| 10 | 1 | 43 |
Table 2. Change in MELD/MELD components from immediately before BRTO to 10 days post-procedure.
| [Delta]MELD | 3.57±3.31 | p= 0.029 |
| [Delta] Creatinine (mg/dL) | 0.58±1.13 | p=0.22 |
| [Delta] Total Bilirubin (mg/dL) | 3.16±3.00 | p=0.02 |
| [Delta] INR | 0.06±0.32 | p=0.60 |
Conclusions: BRTO is a safe procedure that can be utilized in the refractory HE population which is plagued by repeated hospitalizations, long LOS and high healthcare costs. Interestingly, BRTO causes a statistically significant increase in the MELD score and total bilirubin. These changes may better reflect the patients degree of illness hitherto masked by the patients' endogenous shunting.
CITATION INFORMATION: Presser N., DiNorcia J., Agopian V., Yersiz H., Farmer D., Busuttil R., Kaldas F. Balloon-Occluded Retrograde Transvenous Obliteration (BRTO) for the Treatment of Medically Refractory Hepatic Encephalopathy (HE) in Patients with ESLD and Significant Portal-Venous Shunting Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Presser N, DiNorcia J, Agopian V, Yersiz H, Farmer D, Busuttil R, Kaldas F. Balloon-Occluded Retrograde Transvenous Obliteration (BRTO) for the Treatment of Medically Refractory Hepatic Encephalopathy (HE) in Patients with ESLD and Significant Portal-Venous Shunting [abstract]. https://atcmeetingabstracts.com/abstract/balloon-occluded-retrograde-transvenous-obliteration-brto-for-the-treatment-of-medically-refractory-hepatic-encephalopathy-he-in-patients-with-esld-and-significant-portal-venous-shunting/. Accessed May 11, 2025.« Back to 2018 American Transplant Congress