Successful splenorenal shunt occlusion with balloon-occluded retrograde transvenous obliteration yielded improvement of residual liver function, enabled administration of direct-acting antivirals, and achieved sustained virologic response to hepatitis C virus: a case report

We report the use of balloon-occluded retrograde transvenous obliteration (BRTO) for portosystemic shunt in one patient, resulting in marked improvements in residual liver function and enabling safe hepatitis C virus (HCV) elimination with direct-acting antiviral agents. A woman undergoing outpatient treatment at our institution for HCV-related cirrhosis with a history of hepatocellular carcinoma (HCC) treatment developed hepatic encephalopathy (HE; Child-Pugh score 8) at age 65 years. Improvement was obtained with conservative treatment; however, contrast-enhanced computed tomography revealed a splenorenal shunt with decreased portal vein blood flow. Therefore, BRTO was performed to prevent HE recurrence, to improve liver function, and to enable administration of direct-acting antivirals. Postoperatively, marked reduction of the shunt flow was confirmed, and the Child-Pugh score improved from 8 to 5. Subsequent recurrence of HCC was treated with local therapy, after which combination therapy with asunaprevir and daclatasvir was performed, achieving sustained virologic response 24 weeks after completion. No subsequent recurrence of HCC or HE has been observed to date. Copyright © 2017 John Wiley & Sons, Ltd.