title: 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.
abstract: OBJECTIVE
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Vascular Interventional Radiology, Department of Radiology & Medical Imaging, University of Virginia Health System, Charlottesville, VA, USA. wspikes@yahoo.com
authors.forename: Wael E A
authors.initials: WE
authors.lastname: Saad
authors.forename: Cynthia Cindy
authors.initials: CC
authors.lastname: Wagner
authors.forename: Abdulla
authors.initials: A
authors.lastname: Al-Osaimi
authors.forename: Wissam
authors.initials: W
authors.lastname: Bliebel
authors.forename: Allison
authors.initials: A
authors.lastname: Lippert
authors.forename: Mark G
authors.initials: MG
authors.lastname: Davies
authors.forename: Saher S
authors.initials: SS
authors.lastname: Sabri
authors.forename: Ulku C
authors.initials: UC
authors.lastname: Turba
authors.forename: Alan H
authors.initials: AH
authors.lastname: Matsumoto
authors.forename: John Fritz
authors.initials: JF
authors.lastname: Angle
authors.forename: Stephen
authors.initials: S
authors.lastname: Caldwell
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001201:Ascites / Q000209:etiology; D021721:Balloon Occlusion / Q000009:adverse effects; D001663:Bilirubin / Q000097:blood; D015415:Biomarkers / Q000097:blood; D003404:Creatinine / Q000097:blood; D003661:Decision Support Techniques; D004932:Esophageal and Gastric Varices / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D006801:Humans; D006876:Hydrothorax / Q000209:etiology; D019934:International Normalized Ratio; D008107:Liver Diseases / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D015415:Biomarkers; D003404:Creatinine; D001663:Bilirubin
keywords: BRTO; MELD score; gastric varices