Tusanqi-Related Sinusoidal Obstruction Syndrome in China: A Systematic Review of the Literatures.

In West, sinusoidal obstruction syndrome (SOS) is often complicated with hemopoietic stem cell transplantation. By comparison, in China, SOS is frequently caused by Tusanqi-containing pyrrolizidine alkaloids. A systematic review aimed to evaluate the clinical profiles, diagnostic workup, treatment, and outcomes of Tusanqi-related SOS in China. All relevant articles were searched via PubMed, China Knowledge Resource Integrated, VIP, and Wanfang databases. Case reports were defined, as the data were available in every individual patient. Otherwise, case series were defined. Overall, 106 articles were eligible. Fifty-six case reports included 84 individual patients with SOS secondary to Tusanqi alone. All of them presented with ascites, but only 1 patient presented with upper gastrointestinal bleeding. The 1-, 3-, and 6-month cumulative survival rate was 98%, 87%, and 76%, respectively. Increased bilirubin and aspartate transaminase levels were significantly associated with poor outcome. Thirty-one case series included 402 patients with SOS secondary to Tusanqi alone. Ascites was observed in 94% of patients, but upper gastrointestinal bleeding was observed in 40% of patients. Recovery, stabilization, progression, and death were observed in 41%, 30%, 14%, and 16% of patients, respectively. Nineteen case series included 281 patients with SOS secondary to mixed etiologies. The pooled proportion of Tusanqi-related SOS was 66% (95% confidence interval: 56%-75%). Tusanqi is a major cause of SOS in China. Ascites is the most common clinical presentation of Tusanqi-related SOS. Despite a relatively good short-term outcome, further studies should be necessary to explore the long-term outcome and refine the treatment strategy.