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.