The effect of balloon-occluded transvenous obliteration of gastric varices and gastrorenal shunts on the hepatic synthetic function: A comparison between child-pugh and model for end-stage liver disease scores

Wael E.A. Saad, Cynthia Wagner, Abdulla Al-Osaimi, Wissam Bliebel, Allison Lippert, Mark G. Davies, Saher S. Sabri, Ulku C. Turba, Alan H. Matsumoto, John Angle, Stephen Caldwell

Research output: Contribution to journalArticle

16 Scopus citations

Abstract

Purpose: To evaluate the effect of balloon-occluded transvenous obliteration (BRTO) on the model for end-stage liver disease (MELD) and the Child-Pugh (C-P) score and their individual components. Methods: A retrospective review of patients undergoing only BRTO without transjugular intrahepatic portosystemic shunt was performed (08, 2007 to 06, 2010). Pre- and post-BRTO MELD and C-P scores were calculated. The post-BRTO MELD and C-P score samplings were categorized as (1) immediate (within 14 days), (2) early (14-90 days), and (3) delayed (90-180 days) post-BRTO. The C-P and MELD scores and their individual components before and after (various sample intervals) were compared. Results: A total of 29 consecutive successful BRTO procedures were found and assessed. In all, 26 had immediate post-BRTO sampling (average 1.8 days after BRTO), 13 (57%) had an early post-BRTO sampling (average 47 days from BRTO), and 10 (38%) had a delayed post-BRTO sampling (average 121 days from BRTO). The bilirubin rises significantly (P = .007) within days after BRTO, but synthetic function improves significantly between 1.5 and 4.0 months post-BRTO (international normalized ration: P = .02, bilirubin: P = .027, and albumin: P = .012). However, 31% (N = 8/ 26) of the patients had worsening ascites with or without hydrothorax. The MELD score significantly improved circa 4 months post-BRTO (from 14.1 to 10.7, P = .0008). However, the C-P score did not change significantly (from 7.6 to 6.7, P = .063). Conclusion: The BRTO has a positive effect on the hepatic synthetic function. However, there is a high incidence of post-BRTO ascites (31% of the patients). As a result, the MELD score appears to be a more sensitive gauge for hepatic synthetic function compared to the C-P score for patients undergoing BRTO.

Original languageEnglish (US)
Pages (from-to)281-287
Number of pages7
JournalVascular and Endovascular Surgery
Volume47
Issue number4
DOIs
StatePublished - May 2013
Externally publishedYes

Keywords

  • BRTO
  • MELD score
  • gastric varices

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

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