Reversion of liver cirrhosis after endovascular treatment in Chinese patients with Budd-Chiari syndrome

Aims: To investigate the impact of endovascular (EV) treatment on liver cirrhosis in Chinese patients with Budd-Chiari syndrome (BCS). Methods: From September 2011 to March 2022, 97 patients from four hospitals in China who were diagnosed with primary BCS complicated with liver cirrhosis and received EV treatment were retrospectively enrolled in this study for clinical analysis. In addition, liver tissues for basic research were acquired from 25 patients between June 2022 and March 2023, including six with benign liver tumors, 11 with BCS before EV treatment, and eight with EV-treated BCS. Liver cirrhosis was assessed by clinical outcomes, histological studies, and the expression of related genes at the mRNA and protein levels. Results: The patients with BCS had better liver function after EV treatment, evidenced by an increased albumin level and reduced total bilirubin, ALT, and AST. The imaging findings suggested an amelioration of liver cirrhosis and portal hypertension, including increased portal vein velocity (13.52 +/- 8.89 cm/s vs. 17.51 +/- 6.67 cm/s, p < 0.001) and decreased liver stiffness (30.37 +/- 6.39 kPa vs. 23.70 +/- 7.99 kPa, p < 0.001), portal vein diameter (14.97 +/- 3.42 mm vs. 13.36 +/- 2.89 mm, p < 0.001), and spleen volume (870.00 +/- 355.61 cm(3) vs. 771.36 +/- 277.45 cm(3), p < 0.001). Furthermore, histological studies revealed that EV treatment resulted in a restoration of liver architecture with reduced extracellular matrix deposition. Meanwhile, hepatic angiogenesis and inflammation, which have a close relationship with cirrhosis, were also inhibited. In addition, the state of hepatocytes switches from apoptosis to proliferation after EV treatment. Conclusions: BCS-induced liver cirrhosis could be reversed by EV treatment from macroscopic to microscopic dimensions. Our study may provide further insights into understanding BCS and treating cirrhosis.