7%2 to 42%3 and poor 5-year transplantation-free survival of 28%3 for primary BCS. We aimed to investigate the epidemiology, natural history and outcomes of BCS patients at Austin Health. Method: This study was retrospective and was performed at the Austin Hospital. We searched the hospitals computerised diagnosis database and the hospital’s liver transplant database for cases of Budd Chiari syndrome from January 2000

until August 2012. Patients with hepatic venous outflow obstruction at any point from the small hepatic veins to the inferior vena cava were included. Patients with secondary Budd Chiari syndrome were excluded. Results: Median age at diagnosis was 42 years (range 21–76). 59% were female. Eight patients (30%) had concomitant portal vein thrombosis (PVT). Twenty four patients (89%) had learn more at least one identifiable risk factor. The most common risk factor was myeloproliferative neoplasm check details (MPN, n = 16) with polycythaemia rubra vera (PRV) being the most common subtype. JAK-2 was positive in 12 of 18 patients tested. The primary intervention was transjugular intrahepatic portosystemic shunting (TIPS) in thirteen patients (48%) and angioplasty/stenting in eleven

(41%). One patient had a splenorenal shunt. No patients required transplantation during the 10 year follow up period. At median follow-up of 5 years; 16 patients had compensated liver disease, 3 had decompensated liver disease, 2 patients died a liver related death (one from hepatorenal syndrome and bilateral pulmonary Astemizole emboli, one death secondary to hepatic encephalopathy) , 4 died from a non liver related death and 2 patients were lost to follow-up. The overall transplant free one year survival was 96% and 81% at five years. Discussion: In this retrospective study, we aimed to characterise the aetiology and treatment outcomes of patients with Budd Chiari syndrome treated in our institution. This is the only published cohort

of Budd Chiari patients where no liver transplantations were required. We postulate that this is due to intensive TIPS surveillance at our hospital to prevent TIPS failure. MPN is the most common aetiological factor in BCS. This can be missed at diagnosis, and all patients should have JAK2 testing or bone marrow biopsy. TIPS or angioplasty/stenting, together with anticoagulation and treatment of any MPN, results in favourable long term transplantation-free outcomes and represents optimal standard of care. (1) Plessier A et al, Management of hepatic vascular disorders, Journal of Hepatology. 2012, S25–38 (2) Seijo, Plessier et al. Good-long term outcome of Budd-Chiari Syndrome with a Step-wise approach. Hepatology. 2013.