Transjugular Intrahepatic Portosystemic Shunt Placement in Patients with Schistosomiasis-Induced Liver Fibrosis

Jiacheng Liu,Qin Shi,Gansheng Feng,Chuansheng Zheng,Chen Zhou,Bin Xiong,Dongpin Chen,Yan Ge,Feng Yuan,Binqian Zhou

doi:10.1007/s00270-019-02295-6

Abstract

PurposeEvaluate the efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) insertion on patients with schistosomiasis-induced liver fibrosis, and compare with that of patients with HBV-induced cirrhosis.Materials and MethodsThis was a retrospective study from November 2015 to December 2018 including 82 patients diagnosed with portal hypertension, one group of which is induced by schistosomiasis (n = 20), the other by hepatitis B virus (HBV) (n = 62). Both groups of subjects underwent TIPS placement for the management of portal hypertension complications.ResultsTIPS was inserted successfully in all patients (technical success 100%). After a median follow-up of 14 months following TIPS insertion, portal pressure gradient (PPG) value in both schistosomiasis-induced group and HBV-induced group underwent a significant decrease with no major difference between the two groups. There exists no significant difference demonstrated by Kaplan–Meier curves between two groups concerning cumulative rate of hepatic encephalopathy (HE) (log-rank p = 0.681), variceal rebleeding (log-rank p = 0.837) and survival (log-rank p = 0.429), and no statistically difference was found in terms of alleviation of portal vein thrombosis (PVT). In addition, splenectomy (HR 19, 95% CI 4–90, p < 0.001) was identified as independent predictor of PVT.ConclusionsTIPS placement is well-founded to be considered as a safe and effective treatment in patients with schistosomiasis-induced portal hypertension and relevant severe complications. We also found the risk of PVT is 19 times higher in patients who underwent splenectomy than in untreated patients.Level of EvidenceHistorically controlled studies, level 4.

Highlights

Schistosomiasis, a generally incurable and highly infectious disease, has gained stepwise attention over the decades
Bold values indicate statistical significance aMELD model of end-stage liver disease [39] bPVT Portal vein thrombosis, the PVT location consists of the main portal vein (MPV), superior mesenteric vein (SMV) and splenic vein (SV)
Whose severity was divided into four levels: grade 0, grade I (MPV thrombus \ 50% or only SMV and SV thrombus existed), grade II (MPV thrombus accounted for 50–100%) and grade III [40, 41]

Summary

Introduction

Schistosomiasis, a generally incurable and highly infectious disease, has gained stepwise attention over the decades. Mass drug administration (MDA) programs have been used for many years, there are still 240 million people being affected with schistosomiasis worldwide currently [1, 2]. Schistosomiasis is a snail-borne disease caused by trematodic worms of genus schistosoma, which includes three main species, Schistosoma haematobium, Schistosoma mansoni and Schistosoma japonicum [3, 4]. Schistosoma haematobium causes urogenital schistosomiasis, and other species cause intestinal schistosomiasis. In China, the most common one is schistosoma japonicum, J. Liu et al.: Transjugular Intrahepatic Portosystemic Shunt Placement in Patients with

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