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http://hdl.handle.net/2445/160520
Title: | Congenital extrahepatic portosystemic shunts (Abernethy malformation): An international observational study |
Author: | Baiges Aznar, Anna Turon, Fanny Simón Talero, Macarena Tasayco, Stephanie Bueno, Javier Zekrini, Kamal Plessier, Aurélie Franchi-Abella, Stéphanie Guerin, Florent Mukund, Amar Eapen, C.E. Goel, Ashish Shyamkumar, Nidugala K. Coenen, Sandra Gottardi, Andrea de Majumdar, Avik Onali, Simona Shukla, Akash Carrilho, Flair José Nacif, Lucas Primignani, Massimo Tosetti, Giulia La Mura, Vincenzo Nevens, Frederick Witters, Peter Tripathi, Dhiraj Tellez, Luis Martínez González, Javier Álvarez-Navascués, Carmen López Fraile López, Miguel Procopet, Bogdan Piscaglia, Fabio Koning, Barbara de Llop, Elba Romero Cristobal, Mario Tjwa, Eric Monescillo-Francia, Alberto Senzolo, Marco Perez-LaFuente, Mercedes Garcia Criado, María Ángeles Segarra, Antonio Kumar Sarin, Shiv Hernández Gea, Virginia Patch, David Laleman, Wim Hartog, Hermien Valla, Dominique Genescà, Joan García Pagán, Juan Carlos |
Keywords: | Malalties del fetge Malalties hereditàries Liver diseases Genetic diseases |
Issue Date: | 18-Jun-2019 |
Publisher: | Wiley |
Abstract: | Congenital extrahepatic portosystemic shunt (CEPS) or Abernethy malformation is a rare condition in which splanchnic venous blood bypasses the liver draining directly into systemic circulation through a congenital shunt. Patients may develop hepatic encephalopathy (HE), pulmonary hypertension (PaHT), or liver tumors, among other complications. However, the actual incidence of such complications is unknown, mainly because of the lack of a protocolized approach to these patients. This study characterizes the clinical manifestations and outcome of a large cohort of CEPS patients with the aim of proposing a guide for their management. This is an observational, multicenter, international study. Sixty-six patients were included; median age at the end of follow-up was 30 years. Nineteen patients (28%) presented HE. Ten-, 20-, and 30-year HE incidence rates were 13%, 24%, and 28%, respectively. No clinical factors predicted HE. Twenty-five patients had benign nodular lesions. Ten patients developed adenomas (median age, 18 years), and another 8 developed HCC (median age, 39 years). Of 10 patients with dyspnea, PaHT was diagnosed in 8 and hepatopulmonary syndrome in 2. Pulmonary complications were only screened for in 19 asymptomatic patients, and PaHT was identified in 2. Six patients underwent liver transplantation for hepatocellular carcinoma or adenoma. Shunt closure was performed in 15 patients with improvement/stability/cure of CEPS manifestations. Conclusion: CEPS patients may develop severe complications. Screening for asymptomatic complications and close surveillance is needed. Shunt closure should be considered both as a therapeutic and prophylactic approach. |
Note: | Versió postprint del document publicat a: https://doi.org/10.1002/hep.30817 |
It is part of: | Hepatology, 2019, vol. 71, num. 2, p. 658-669 |
URI: | http://hdl.handle.net/2445/160520 |
Related resource: | https://doi.org/10.1002/hep.30817 |
ISSN: | 0270-9139 |
Appears in Collections: | Articles publicats en revistes (IDIBAPS: Institut d'investigacions Biomèdiques August Pi i Sunyer) Articles publicats en revistes (Fonaments Clínics) |
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