Budd–Chiari syndrome in very young adult patients with polycythemia vera: report of case series with good outcome with direct thrombin inhibitor treatment

Clinical Efficacy of Spectral Computed Tomography for Evaluating Liver Function in Patients with Budd-Chiari Syndrome

RATIONALE AND OBJECTIVES

To analyze the clinical relevance of quantitative spectral parameters in evaluating the treatment of patients with Budd-Chiari syndrome (BCS) with different classes of liver function by comparing normalized iodine concentration (NIC) before and after BCS treatment.

MATERIALS AND METHODS

Angiographic data were obtained from 41 patients with confirmed BCS between December 2015 and March 2017. All patients underwent spectral computed tomography (CT) before and after BCS treatment; the average interval between scans was 2-4 months. Iodine concentration and NIC were measured and calculated during the portal venous phase in liver segments I-VIII. Clinical liver function parameters including prothrombin time (PT), albumin (ALB), total bilirubin (TBIL), aspartate aminotransferase, and alanineaminotransferase were recorded. Liver function was classified according to the Child-Pugh grading standard (before treatment). Liver NIC and liver function-related parameters before and after treatment were compared using the paired t-test; Pearson correlation analysiswas performed to analyze the aforementioned parameters among different liver function classes before BCS treatment. p < 0.05 was to be statistically considered significant.

RESULTS

PT and TBIL were negatively correlated with liver NIC (p < 0.05), whereas ALB and liver NIC exhibited a positive correlation (p < 0.05). Comparison of NIC before and after treatment revealed that NIC in liver segments I-VIII was higher after treatment. The p values for segments II-VIII were 0.041, 0.046, 0.041, 0.038, 0.039, 0.042, and 0.040, respectively; the differences were statistically significant (p < 0.05). The increase in NIC in liver segments I-VIII before and after treatment was more significant in patients with class C liver function than in their class B and A counterparts. Comparison of liver function-related parameters revealed that PT was shortened after treatment; ALB levels were increased; and TBIL, alanine aminotransferase, and aspartate aminotransferase levels were decreased.

CONCLUSION

NIC determined through spectral CT was beneficial for evaluating liver function in patients with BCS, and can provide imaging data for reexamination, prognostic evaluation, and follow-up of patients with BCS after treatment. Liver parenchyma NIC values in BCS patients with varying liver function may provide a degree of diagnostic value. Multi-locus and multi-parameter studies of spectral CT can help to further evaluate liver function and assess prognosis in patients with BCS.

Characteristics and outcomes of patients with essential thrombocythemia or polycythemia vera diagnosed before 20 years of age: a systematic review

Although it is well known that myeloproliferative neoplasms occur in younger patients, few large cohorts of such patients have been reported. Thus, our knowledge about circumstances of diagnosis, outcome and treatment is limited, especially for children and young adults. We therefore performed a systematic review of cases, published since 2005, concerning patients aged below 20 years at the time of diagnosis of essential thrombocythemia or polycythemia vera. We identified 396 cases of essential thrombocythemia and 75 of polycythemia vera. The median age at diagnosis was 9.3 and 12 years, respectively, and females constituted 57.6% and 45% of the groups, respectively. Half of the patients were asymptomatic at diagnosis. The proportion of so-called triple negativity was high: 57% in essential thrombocythemia and 73% in polycythemia vera. The incidence of thrombosis during the follow-up was 9.3% in patients with polycythemia vera and less, 3.8%, in those with essential thrombocythemia. Venous events were predominant (84.2%), with hemorrhagic episodes being rarer (<5%). The risk of evolution also seemed low (2% to myelofibrosis and no reports of acute leukemia), but the median follow-up was only 50 months. Survival curves were not available. Half of the patients received an antithrombotic drug and 40.5% received a cytoreductive drug. All data should be analyzed with care because of the proportion of missing data (10.7% to 74.7%). This review highlights interesting points concerning this population of young patients with myeloproliferative neoplasms, including that such patients were identified as negative for all common driver mutations, but also shows the need for larger contemporary cohorts with longer follow-up to assess the true prognosis of these patients.

Budd-Chiari Syndrome in Young Chinese: Clinical Characteristics, Etiology and Outcome of Recanalization from a Single Center

PURPOSE

We aimed to characterize the clinical profile, etiology, and outcomes of young Chinese patients with Budd-Chiari syndrome treated with recanalization.

METHODS

A total of 35 consecutive young patients (≤25 years of age) with primary Budd-Chiari syndrome treated with recanalization at our center were enrolled in this study between March 2011 and December 2014. Data on baseline information, etiology tests, therapeutic recanalization strategies, and follow-up were collected.

RESULTS

The most common clinical feature was ascites, present in 33 cases (94%). Hepatic vein obstruction was present in 60% (21/35) of patients, inferior vena cava obstruction in 3% (1/35), and combined obstruction in 37% (13/35). The most common risk factor for thrombosis was hyperhomocysteinemia (14/35, 40%). Recanalization was technically successful in 32 of 35 patients (91%), and clinically successful in 28 of these 32 patients (88%). The cumulative 1- and 3-year primary patency rates were 75.2 and 54.3%, respectively. The cumulative 1- and 3-year secondary patency rates were 89.3 and 89.3%, respectively. The cumulative 1- and 3-year survival rates were 96.9 and 93.8%, respectively.

CONCLUSION

In this study, the most common type of lesion was hepatic vein obstruction, the most common thrombotic risk factor was hyperhomocysteinemia, and recanalization resulted in good mid-term outcomes in young Chinese patients with Budd-Chiari syndrome.