Comparison of Transjugular Intrahepatic Portosystemic Shunt in the Treatment of Cirrhosis With or Without Portal Vein Thrombosis: A Retrospective Study.

Hong-Liang Wang,Tan-Yang Zhou,Guan-Hui Zhou,Zi-Niu Yu,Tong-Yin Zhu,Chun-Hui Nie,Yue-Lin Zhang,Sheng-Qun Chen,Bao-Quan Wang,Jun-Hui Sun,Wei-Jie Lu,Li Jing

doi:10.3389/fmed.2021.737984

Abstract

Aim: The purpose of our study was to conduct a retrospective analysis to compare the effectiveness of transjugular intrahepatic portosystemic shunts (TIPS) in the treatment of patients with cirrhosis with or without portal vein thrombosis (PVT).Methods: We included a total of 203 cirrhosis patients successfully treated with TIPS between January 2015 and January 2018, including 72 cirrhosis patients with PVT (35.5%) and 131 without PVT (64.5%). Our subjects were followed for at least 1 year after treatment with TIPS. Data were collected to estimate the mortality, shunt dysfunction, and complication rates after TIPS creation.Results: During the mean follow-up time of 19.5 ± 12.8 months, 21 (10.3%) patients died, 15 (7.4%) developed shunt dysfunction, and 44 (21.6%) experienced overt hepatic encephalopathy (OHE). No significant differences in mortality (P = 0.134), shunt dysfunction (P = 0.214), or OHE (P = 0.632) were noted between the groups. Age, model for end-stage liver disease (MELD) score, and refractory ascites requiring TIPS were risk factors for mortality. A history of diabetes, percutaneous transhepatic variceal embolization (PTVE), 8-mm diameter stent, and platelet (PLT) increased the risk of shunt dysfunction. The prevalence of variceal bleeding and recurrent ascites was comparable between the two groups (16.7 vs. 16.7% P = 0.998 and 2.7 vs. 3.8% P = 0.678, respectively).Conclusions: Transjugular intrahepatic portosystemic shunts are feasible in the management of cirrhosis with PVT. No significant differences in survival or shunt dysfunction were noted between the PVT and no-PVT groups. The risk of recurrent variceal bleeding, recurrent ascites, and OHE in the PVT group was generally similar to that in the no-PVT group. TIPS represents a potentially feasible treatment option in cirrhosis patients with PVT.

Highlights

Portal vein thrombosis (PVT) is an important complication of cirrhosis but is not common in the general population
Indications for Transjugular intrahepatic portosystemic shunts (TIPS), 90-Day Mortality, Mortality, Diameter of stent, Overt hepatic encephalopathy, Recurrent variceal bleeding, Recurrent ascites, Antiplatelet treatments, percutaneous transhepatic variceal embolization (PTVE), pressure gradient (PSG) before TIPS, PSG after TIPS, Liver transplantation, Shunt dysfunction compared between patients with and without PVT
Hepatitis B, non-alcoholic steatohepatitis (NASH)/cryptogenesis, and liver disease caused by alcohol were identified as the most common causes of cirrhosis

Summary

Introduction

Portal vein thrombosis (PVT) is an important complication of cirrhosis but is not common in the general population. PVT in cirrhosis may be associated with a reduction in the portal vein blood flow velocity, a high coagulation state, and vascular endothelial injury [6,7,8]. Anticoagulant therapy is recommended as the preferred treatment option for PVT, but anticoagulation is a challenging therapy in patients with liver cirrhosis given the well-recognized coagulation abnormalities [9]. The occurrence of PVT is typically not evident, and most patients are complicated with portal hypertension [10, 11]. The purpose of our study was to conduct a retrospective analysis to compare the effectiveness of TIPS in the treatment of patients with cirrhosis with or without PVT in our center

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