title: Long-term clinical outcome of Budd-Chiari syndrome in children after radiological intervention.
abstract: OBJECTIVE
  Budd-Chiari syndrome (BCS) is an uncommon cause of chronic liver disease in children. The literature on the management of pediatric BCS is scarce. Our aim was to determine the long-term outcome of patients undergoing a radiological intervention for the treatment of BCS.
  
  
  METHODS
  Thirty-two children diagnosed with BCS between 2004 and 2014 were included. Data on the course of disease, medical management, response, and complications related to radiological interventions and outcome were collected.
  
  
  RESULTS
  Twenty-five patients who were on regular follow-up were analyzed. The median age of the patients at presentation was 9 months (4.5-214). Sixteen patients initially received anticoagulation alone. This was associated with a high failure rate of 66%. Twenty patients underwent a radiological intervention in the form of angioplasty (n=7), hepatic vein stenting (n=3) or transjugular intrahepatic portosystemic shunt (TIPS) (n=14). Success with angioplasty was achieved in 43% of cases. Hepatic vein stenting was successful in 66%, whereas TIPS was successful in 72% of cases. TIPS was feasible in all patients. The median follow-up duration was 44 months (5-132). Four patients developed hepatopulmonary syndrome after a median period of 3 years (1.5-5.25) and one patient developed hepatocellular carcinoma.
  
  
  CONCLUSIONS
  BCS commonly presents during infancy. Anticoagulation alone and angioplasty of the hepatic veins are associated with a high failure rate. Hepatic vein stenting or TIPS is feasible and efficacious in improving liver function, portal hypertension, and growth. It is associated with good long-term outcome and delays the need for liver transplantation, but may not prevent complications such as hepatopulmonary syndrome and hepatocellular carcinoma.
authors.affiliation: Departments of aPediatrics bInterventional Radiology cGastroenterology, Jaslok Hospital and Research Institute, Mumbai, Maharashtra, India.
authors.forename: Varun K
authors.initials: VK
authors.lastname: Sharma
authors.forename: Prajakta R
authors.initials: PR
authors.lastname: Ranade
authors.forename: Shaji
authors.initials: S
authors.lastname: Marar
authors.forename: Fazal
authors.initials: F
authors.lastname: Nabi
authors.forename: Aabha
authors.initials: A
authors.lastname: Nagral
mesh_terms: D000293:Adolescent; D000367:Age Factors; D017130:Angioplasty / Q000009:adverse effects / Q000295:instrumentation; D000925:Anticoagulants / Q000627:therapeutic use; D006502:Budd-Chiari Syndrome / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006503:Hepatic Veins / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D007223:Infant; D008297:Male; D017082:Portal Pressure; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000009:adverse effects; D015641:Radiography, Interventional / Q000009:adverse effects; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants