Liver Transplantation Outcomes for Budd-Chiari Syndrome in the MELD Era
1King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia, 2The Institute for Translational Medicine and Therapeutics, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 3School of Medicine, School of Public Health, School of Arts and Sciences, University of Alabama at Birmingham, Birmingham, AL, 4Division of Gastroenterology & Hepatology, Johns Hopkins University, Baltimore, MD, 5Department of Internal Medicine, American University of Beirut, Beirut, Lebanon, 6Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
Meeting: 2022 American Transplant Congress
Abstract number: 1107
Keywords: Liver transplantation, Outcome
Topic: Clinical Science » Liver » 60 - Liver: MELD Allocation*
Session Information
Session Time: 7:00pm-8:00pm
Presentation Time: 7:00pm-8:00pm
Location: Hynes Halls C & D
*Purpose: Budd Chiari syndrome (BCS) has a heterogeneous clinical presentations ranging from asymptomatic cases to fulminant liver failure with significant morbidly and mortality. Recent data on the characteristics and outcomes of BCS patients with liver transplantation (LT) and predictors of survival are limited. Our aim was to determine trends and long-term outcomes in recipients of LT for BCS.
*Methods: We extracted data from the UNOS database on all adult (≥ 18 years old) waitlisted candidates and recipients of LT with BCS and restricted analysis to the MELD era (2002-2019). We. Multivariable-adjusted Cox regression was used to estimate hazard ratios. Cox proportional hazards were used to determine predictors of mortality.
*Results: 647 BCS were waitlisted between 2002 and 2019. 58% were female, but 269 patients (42%) were removed from the waitlist without receiving a transplant. In total, 378 (58.4%) BCS patients received a liver transplant at a median age of 41 years. The median calculated MELD in LT recipients was 24 (SD=9) and a total of 48 (13%) recipients were listed as status 1 (Table1). Overall, 121 (32%) patients had a history of trans-jugular intrahepatic portosystemic shunt before LT but this was neither associated with better nor with worse outcomes in transplanted and non-transplanted BCS patients (p=n.s.). Of BCS patients who received LT, more than three-fourths (78.8%) were alive after LT after an up to 15-year follow-up. After 10-year follow-up, survival was highest among BCS patients with TIPS and without LT (82%) followed by those with TIPS and LT (76%). Factors associated with adjusted increased hazards of death after LT were longer length of hospital stay following LT [HR 1.32, 95% CI (1.19-1.47)], Black ethnicity [HR = 2.24, 95% CI (1.38 – 3.64)], diabetes mellitus [HR = 3.17, 95% CI (1.62 – 6.21)] and higher donor recipient index (DRI) [HR = 1.44, 95% CI (1.05 – 1.99)]. Albumin at the time of transplant was negatively associated with up to 15-year survival after LT [HR = 0.66, 95% CI (0.50 – 0.88)]. Interestingly, neither MELD nor prior TIPS showed a significant association with long-term survival after LT.
*Conclusions: This data strongly suggests that LT should not be delayed when conservative measures or shunt procedures fail in patients with BCS, as LT can lead to excellent long-term survival.
To cite this abstract in AMA style:
Alqahtani SA, Schneider C, Sims O, Gurakar A, Tamim H, Bonder A, Saberi B. Liver Transplantation Outcomes for Budd-Chiari Syndrome in the MELD Era [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/liver-transplantation-outcomes-for-budd-chiari-syndrome-in-the-meld-era/. Accessed May 7, 2025.« Back to 2022 American Transplant Congress