Copyright
©The Author(s) 2026. Published by Baishideng Publishing Group Inc. All rights reserved.
Transjugular intrahepatic portosystemic shunt improves survival in anticoagulation-resistant hepatic sinusoidal obstructive syndrome patients: A multicenter retrospective study
Jing-Jing Tu, Han Zhang, De-Run Kong, Yan-Hong Feng, Yue-Cheng Yu, Tai-Shun Li, Feng Zhang, Wei Zhang, Hui Xu, Qin Yin, Lei Wang, Ming Zhang, Jiang-Qiang Xiao, Yu-Zheng Zhuge
Jing-Jing Tu, Han Zhang, Feng Zhang, Wei Zhang, Hui Xu, Qin Yin, Lei Wang, Jiang-Qiang Xiao, Yu-Zheng Zhuge, Department of Gastroenterology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210000, Jiangsu Province, China
De-Run Kong, Department of Gastroenterology, First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
Yan-Hong Feng, Nanjing University of Chinese Medicine, Nanjing Second Hospital, Nanjing 210008, Jiangsu Province, China
Yue-Cheng Yu, Liver Disease Center, Bayi Hospital, Nanjing University of Chinese Medicine, Nanjing 210002, Jiangsu Province, China
Tai-Shun Li, Medical Statistics and Analysis Center, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210000, Jiangsu Province, China
Ming Zhang, Department of Hepatology, Beijing Ditan Hospital, Beijing 100015, China
Co-corresponding authors: Jiang-Qiang Xiao and Yu-Zheng Zhuge.
Author contributions: Tu JJ, Zhang H, Wang L, Zhang M, Xiao JQ and Zhuge YZ contributed to the conception and design of the study; Tu JJ, Kong DR, Feng YH, Yu YC, Li TS, Zhang F, Zhang W, Xu H, and Yin Q contributed to data acquisition, data analysis and interpretation; Xiao JQ and Zhuge YZ have played important and indispensable roles in the conception and design of the study as co-corresponding authors; all authors made critical revisions of the draft versions of manuscript and approved the final manuscript.
Supported by National Natural Science Foundation of China, No. 82100652; and Nanjing Drum Tower Hospital Youth Development Program, No. 2024-LCYJ-PY-27.
Institutional review board statement: This study was approved by the Ethics Committees of Nanjing Drum Tower Hospital (No. 2022-392-02). The study was conducted in accordance with the Helsinki Declaration and good clinical practices.
Informed consent statement: Written informed consent was waived by the ethics committees of Nanjing Drum Tower Hospital.
Conflict-of-interest statement: All authors declare no conflict of interest in publishing the manuscript.
Data sharing statement: All data and materials are available from the corresponding author on reasonable requests.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Jiang-Qiang Xiao, PhD, Department of Gastroenterology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing 210000, Jiangsu Province, China.
josedy@126.com
Received: September 3, 2025
Revised: October 2, 2025
Accepted: December 10, 2025
Published online: February 27, 2026
Processing time: 162 Days and 22.3 Hours
BACKGROUND
Anticoagulation therapy is recommended during the acute or subacute stage for patients with pyrrolizidine alkaloid-hepatic sinusoidal obstruction syndrome (PA-HSOS). Transjugular intrahepatic portosystemic shunts (TIPS) is suggested as a step-up treatment when patients do not respond to anticoagulants. However, more evidence of the efficacy of TIPS is needed.
AIM
To evaluate the effect of TIPS in these patients.
METHODS
Between January 2013 and September 2020, we retrospectively enrolled patients with PA-HSOS who did not respond to short-term anticoagulation therapy at four hospitals. The patients were divided into a TIPS treatment group and an anticoagulation therapy group. Baseline information and clinical characteristics were collected and recorded. Survival in both groups was the primary study endpoint and the risk factors for patient death were further analyzed.
RESULTS
A total of 99 patients were enrolled according to the inclusion and exclusion criteria (63 in the TIPS group and 36 in the anticoagulation therapy group). There were 17 deaths during the median follow-up time of 32.5 months. Treatment, age, aspartate aminotransferase, and serum total bilirubin were independent risk factors for predicting death. The survival of patients in the TIPS group was significantly greater than that of patients in the continuing anticoagulation therapy group (P = 0.028). When stratified by the Drum-Tower Severity Scoring, in the TIPS group, mild and moderate patients had better outcomes than severe patients.
CONCLUSION
TIPS can improve the transplant-free survival rate in patients with PA-HSOS who do not respond to short-term anticoagulation therapy, and patients with mild and moderate Drum-Tower Severity Scoring grade can benefit from TIPS.
Core Tip: Transjugular intrahepatic portosystemic shunts (TIPS) could improve the survival rate of pyrrolizidine alkaloid-hepatic sinusoidal obstruction syndrome patients who have no response to initial short-term anticoagulation therapy, and patients with Drum-Tower Severity Scoring of mild and moderate grade could benefit from TIPS. More active and earlier TIPS can be considered in patients with no response to anticoagulation therapy.
