Long-term outcomes of plug-assisted retrograde transvenous obliteration (PARTO) for refractory hepatic encephalopathy.

Abstract

To evaluate the efficacy and long-term outcomes of plug-assisted retrograde transvenous obliteration (PARTO) for the treatment of medically refractory hepatic encephalopathy (HE). Fifty-eight patients with cirrhosis who presented with one or more types of large portosystemic shunt (PSS) between April 2009 and March 2023 and had a history of at least two episodes of recurrent HE in the preceding 6 months were included in this retrospective study. Clinical follow-up included venous ammonia and West Haven (WH) score assessment. Technical and long-term outcomes were reviewed and analyzed. The technical success rate was 98.3% (57 of 58 patients). The mean procedure time was 29 min (range, 9-114 min). The immediate clinical success rate was 98.3%. The median WH score improved significantly from 2 (range, 1-3) pre-PARTO to 0 (range, 0-1) post-PARTO (p < 0.001). The mean serum ammonia level, which was 82.4 µmol/dL ± 46 before PARTO, decreased significantly to 23.7 µmol/dL ± 17 within 1 week after PARTO (p < 0.001). Long-term follow-up data were available for only 48 patients because of early death (n = 2), follow-up loss (n = 2), or liver transplantation (n = 5). The obliteration rate of PSS was 100%. Nine (18.8%) patients experienced recurrence of HE at a mean of 19.6 months (range 1.5-32.8 months). The cumulative 1-, 2-, 3-, 5-, and 10-year recurrence rates of HE were 6.4%, 14.9%, 27.5%, 27.5%, and 27.5%, respectively. The median transplantation-free survival time was 45.7 months (95% confidence interval, 25-66.5 months). High clinical success rate and low recurrence rate of HE during the long-term follow-up period suggest that PARTO is an effective treatment for refractory HE due to PSS in patients with liver cirrhosis. Question The efficacy and long-term outcomes of plug-assisted retrograde transvenous obliteration for patients with hepatic encephalopathy have not yet been strictly determined. Findings The clinical symptoms of hepatic encephalopathy completely resolved in 57 (98.3%) of 58 patients within 2 days after plug-assisted retrograde transvenous obliteration. Clinical relevance Long-term outcomes suggest that plug-assisted retrograde transvenous obliteration is an effective treatment for refractory hepatic encephalopathy due to portosystemic shunt in patients with liver cirrhosis.