Improvement of hepatic reserve and changes in liver and spleen volume after balloon-occluded retrograde transvenous obliteration

BACKGROUND AND AIMS: Improvement in hepatic reserve after balloon-occluded retrograde transvenous obliteration (BRTO) in patients with gastric varices (GVs) has not been fully established. The relationship between increases in liver volume (LV) or splenic volume (SV) after BRTO and prognosis is still unclear. In this study, we aimed to evaluate the factors associated with improvement in hepatic reserve after BRTO in GV patients and the relationship between changes in LV or SV after BRTO and prognosis. METHODS: We retrospectively enrolled 258 patients who recieved their first BRTO for GV treatment at 12 institutions between January 2004 and May 2019. Hepatic reserve, LV, and SV were evaluated before and 6 months after BRTO. RESULTS: Changes in hepatic reserve were evaluated in 160 patients. Albumin levels and prothrombin time-international normalized ratio improved significantly, while platelet counts decreased significantly at 6 months after BRTO. Multivariate logistic regression analysis showed that history of hepatocellular carcinoma and modified albumin-bilirubin (mALBI) grade were independent factors associated with the improvement of albumin-bilirubin (ALBI) score. The ALBI score significantly improved in patients with mALBI grade 2b or 3 (p < 0.001), but not in patients with mALBI grade 1 or 2a. Eighty-three patients who underwent abdominal computed tomography examination 6 months after BRTO had significantly increased LV and SV (LV, p < 0.01; SV, p < 0.01). The patients with a > 10% increase in SV had significantly poorer prognosis than the others (p = 0.03). CONCLUSIONS: BRTO for GVs leads to improvement of hepatic reserve. Patients with increased SV after BRTO had poor prognosis. TRIAL REGISTRATION: Not aplicable.