Sa1023 A Prospective Evaluation of Multi-Factors on the Efficacy of Transjugular Intrahepatic Portosystemic Shunt in the Patients With Hepatitis B Virus Related Hepatic Cirrhosis

Abstract

Background: Variceal bleeding is the third cause of deaths from cirrhosis. Numerous treatments for variceal bleeding are available. Treatment with a transjugular intrahepatic portosystemic shunt (TIPS) combined with adjunctive embolotherapy of gastroesophageal collateral vessels (AEGCV) is expected to further reduce the rate of rebleeding through embolization of persistent patent collaterals. In addition, it was reported that anticoagulation agents may partly reduce the shunt occlusion before the application of covered stent and the oral antiviral drugs could improve underlying liver function in decompensated patients. However, the long term survival of cirrhotic patients after TIPS creation is still not optimal due to the mortality may be determined by multi-factors. Objective: This prospective study was aimed to investigate the effects of TIPS combined with AEGCV, aspirin administration and antiviral drug on the shunt patency, rebleeding and survival. Methods: 114 eligible patients with hepatitis B virus (HBV) related-hepatic cirrhosis were included and were randomly assigned into the TIPS alone (n=57) and TIPS +AEGCV (n=57) groups. Aspirin was prescribed to all of them and adefovir dipivoxil was administrated by the patients with detectable HBV-DNA after TIPS creation. Then all the patients were prospectively followed up between May 2007 and July 2011. The primary outcomes included shunt occlusion, first variceal rebleeding and deaths related to the primary liver diseases, which were estimated by Kaplan-Meier method. The prognostic relevance of treatment and selected variables with respect to patency, rebleeding and survival were analyzed with Cox multivariate analysis. Results: Although the 3 years' cumulative rates of shunt patency, variceal rebleeding and survival of patients in TIPS+AEGCV or TIPS alone groups did not show the significant difference, p>0.05, the cumulative outcomes of shunt patency (90.8%) and variceal rebleeding (3.5%) in TIPS+AEGCV group was significantly better than those (80.7% and 10.1%) in TIPS alone group at half year, p<0.05. The risk ratio (RR) of aspirin administration ≥ 1 year for shunt patency was 0.434, p<0.05. The RRs of aspirin administration ≥ 1 year and shunt patency for variceal rebleeding were 0.487 and 0.301, p<0.05. The 3 years'overall survival rate was 85.1%. Both RRs of Child-Pugh score ≤ 9 (preor post-TIPS) and adefovir administration ≥ 0.5 year for survival were less than 0.3, p<0.05. Conclusion: TIPS combined with sufficient AEGCV and long term administration of aspirin at low dose after TIPS placement are helpful to prolong the survival through keeping shunt patency and controlling variceal rebleeding. For the patients with HBV infection, oral adefovir may further improve the survival.