Association between non-variceal spontaneous portosystemic shunt and outcomes after TIPS in cirrhosis. Issue 12 (December 2018)

• Record Type: Journal Article
• Authors: He, Chuangye; Lv, Yong; Wang, Zhengyu; Guo, Wengang; Tie, Jun; Li, Kai; Niu, Jing; Zuo, Luo; Yu, Tianlei; Yuan, Xulong; Chen, Hui; Wang, Qiuhe; Liu, Haibo; Bai, Wei; Wang, Enxing; Xia, Dongdong; Luo, Bohan; Li, Xiaomei; Yuan, Jie; Han, Na; Zhu, Ying; Wang, Jianhong; Yin, Zhanxin; Fan, Daiming; Han, Guohong
• Is Part Of: Digestive and liver disease. Volume 50:Issue 12(2018)
• Page Start: 1315
• Page End: 1323
• Publication Date: 2018-12
• Subjects: Cirrhosis -- Hepatic encephalopathy -- Spontaneous portosystemic shunt -- Transjugular intrahepatic portosystemic shunt; Digestive organs -- Diseases -- Periodicals; Liver -- Diseases -- Periodicals; 616.33005
• DOI: 10.1016/j.dld.2018.05.022
• Languages: English
• ISSNs: 1590-8658

Abstract

Abstract: Background: Whether pre-existing nonvariceal spontaneous portosystemic shunts (SPSSs) in cirrhotic patients affect outcomes after transjugular intrahepatic portosystemic shunt (TIPS) and whether they need to be closed remains unclear. Aim: To assess the effects of the presence or embolization of SPSSs on outcomes after TIPS for cirrhosis. Methods: From January 2004 to December 2014, 903 consecutive cirrhotic patients who underwent TIPS in a tertiary-care center were included, of which 715 patients had no SPSS (N-SPSS group), 144 patients had an SPSS without embolization (SPSS group), and 44 had an SPSS with embolization (SPSS + E group). Results: During a median follow-up period of 27.7 months, 368 (41%) patients experienced overt hepatic encephalopathy (OHE), 256 (28%) experienced clinical relapse, 164 (18%) developed shunt dysfunction, and 379 (42%) died. The SPSS group had a higher risk of OHE compared with the N-SPSS and SPSS + E groups (adjusted HR [95%CI]: N-SPSS vs SPSS vs SPSS + E: 1 vs 1.36 [1.06–1.75] vs 0.77 [0.46–1.29]; p = 0.027). In stratification analysis, a higher risk of OHE was only observed in patients with a large SPSS (SPSS diameter ≥6 mm) but not a small SPSS. Additionally, SPSS embolization was associated with a lower risk of OHE among patients with a large SPSS (adjust HR = 0.51; 95% CI: 0.29–0.91; p = 0.034). The risks of clinical relapse (p = 0.584), shunt dysfunction (p = 0.267), and mortality (p = 0.4743) did not significantly differ among groups. Conclusions: Among cirrhotic patients undergoing TIPS, a pre-existing large SPSS was associated with a higher risk of OHE, which could be decreased by SPSS embolization. There was no clear association between the presence/embolization of an SPSS and post-TIPS clinical relapse, shunt dysfunction or mortality.