Rotterdam score predicts early mortality in Budd-Chiari syndrome, and surgical shunting prolongs transplant-free survival

Aliment Pharmacol Ther. 2009 Nov 15;30(10):1060-9. doi: 10.1111/j.1365-2036.2009.04134.x. Epub 2009 Sep 1.


Background: Budd-Chiari syndrome carries significant mortality, but factors predicting this outcome are uncertain.

Aim: To determine factors associated with 3-month mortality and compare outcomes after surgical shunting or liver transplantation.

Methods: From 1985 to 2008, 51 patients with Budd-Chiari syndrome were identified.

Results: By logistic regression analysis, features associated with higher risk of 3-month mortality were Rotterdam class III, Clichy >6.6, model for end-stage liver disease (MELD) >20 and Child-Pugh C. Rotterdam class III had the best performance to discriminate 3-month mortality with sensitivity of 0.89 and specificity of 0.63, whereas Clichy >6.60 had sensitivity of 0.78 and specificity of 0.69; MELD >20 had sensitivity of 0.78 and specificity of 0.75 and Child-Pugh C had sensitivity of 0.67 and specificity of 0.72. Eighteen patients underwent surgical shunts and 14 received liver transplantation with no significant differences in survival (median survival 10 +/- 3 vs. 8 +/- 2 years; log-rank, P = 0.9).

Conclusions: Rotterdam score is the best discrimination index for 3-month mortality in Budd-Chiari syndrome and should be used preferentially to determine treatment urgency. Surgical shunts constitute an important therapeutic modality that may help save liver grafts and prolong transplantation-free survival in a selected group of patients with Budd-Chiari syndrome.

Publication types

  • Comparative Study
  • Multicenter Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Budd-Chiari Syndrome / mortality*
  • Budd-Chiari Syndrome / surgery
  • Child
  • Epidemiologic Methods
  • Female
  • Humans
  • Liver Transplantation / mortality*
  • Male
  • Middle Aged
  • Portasystemic Shunt, Surgical / mortality*
  • Treatment Outcome
  • Young Adult