Sarcopenia of Cirrhosis and the Therapeutic Potential of Transjugular Intrahepatic Portosystemic Shunt Creation

2022 ◽  
Author(s):  
Barry Schlansky ◽  
Khashayar Farsad
Keyword(s):  
Transjugular Intrahepatic Portosystemic Shunt ◽  
Observational Studies ◽  
Therapeutic Potential ◽  
Portosystemic Shunt ◽  
Composition Analysis ◽  
Muscle Loss ◽  
Significant Morbidity ◽  
Medical Outcomes ◽  
Intrahepatic Portosystemic Shunt ◽  
The Impact

AbstractSarcopenia is a major sequela of cirrhosis, contributing to significant morbidity and mortality. Advances in body composition analysis using medical imaging have begun to identify changes in skeletal muscle and fat that are prognostic of the impact of sarcopenia on medical outcomes in cirrhosis and other pathologies. Recently, observational studies have shown a correlation between transjugular intrahepatic portosystemic shunt (TIPS) creation and a reversal of the progressive muscle loss in cirrhosis. This reversal is also associated with improved clinical outcomes and survival. This review summarizes current understanding of cirrhotic sarcopenia, and discusses the implications of TIPS creation in reversing this process.

Evaluation of impact of elective invasive examinations in patients with transjugular intrahepatic portosystemic shunt in the long-term follow up

2021 ◽  
Vol 59 (01) ◽  
pp. 24-34
Author(s):  
Leon Louis Seifert ◽  
Dennis Görlich ◽  
Christian Jansen ◽  
Olessja Ortmann ◽  
Martin Schoster ◽  
...  
Keyword(s):  
Transjugular Intrahepatic Portosystemic Shunt ◽  
Portosystemic Shunt ◽  
University Hospitals ◽  
Decompensated Liver Cirrhosis ◽  
Beneficial Impact ◽  
Long Term Follow Up ◽  
Intrahepatic Portosystemic Shunt ◽  
The University ◽  
The Impact

Abstract Introduction In the management of patients with decompensated liver cirrhosis, transjugular intrahepatic portosystemic shunt (TIPS) insertion is well-established but common recommendations in the follow up management are inconsistent. Doppler sonography is commonly used for detection for TIPS dysfunction whilst data on the impact of elective invasive examinations are scarce. Aim The aim of this retrospective analysis is to evaluate potential benefits of elective invasive examinations in the follow up management of patients after TIPS insertion Methods Data of all patients receiving TIPS at the university hospitals of Muenster and Bonn between 2013 and 2018 (n = 534) were collected. The impact of performance of elective invasive examinations at 12 months after TIPS insertion on the occurrence of liver related events (LREs) and frequency of TIPS revisions within 24 months after TIPS insertion was analyzed. Results No significant differences were found concerning occurrence of liver related events after 24 months depending on whether an elective invasive examination was performed. Occurrence of hepatic encephalopathy, relapse of initial indication for TIPS, as well as death or liver transplantation all did not differ. These findings were verified by a subgroup analysis including only patients who did not experience a LRE or TIPS revision within the first 12 months after TIPS procedure. Conclusion The analyzed data suggest no evidence for a beneficial impact due to implementation of an elective invasive examination program after TIPS insertion. Invasive examinations should remain reserved to patients with suspected TIPS dysfunction.

Risk Factors for Hepatic Encephalopathy after Transjugular Intrahepatic Portosystemic Shunt in Patients with Hepatocellular Carcinoma and Portal Hypertension

2015 ◽  
Vol 24 (3) ◽  
pp. 301-307 ◽  
Author(s):  
Jiannan Yao ◽  
Li Zuo ◽  
Guangyu An ◽  
Zhendong Yue ◽  
Hongwei Zhao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hepatocellular Carcinoma ◽  
Portal Hypertension ◽  
Hepatic Encephalopathy ◽  
Pressure Gradient ◽  
Transjugular Intrahepatic Portosystemic Shunt ◽  
Meld Score ◽  
Portosystemic Shunt ◽  
Portal Flow ◽  
Intrahepatic Portosystemic Shunt

Aims: This study aimed at assessing the risk factors for hepatic encephalopathy (HE) after transjugular intrahepatic portosystemic shunt (TIPS) in patients with hepatocellular carcinoma (HCC) and portal hypertension. Method: Consecutive patients (n=279) with primary HCC who underwent TIPS between January 1997 and March 2012 at a single institution were retrospectively reviewed. Patients were followed up for 2 years. Pre-TIPS, peri-TIPS and post-TIPS clinical variables were reviewed using univariate and multivariate analyses to identify risk factors for HE after TIPS. Results: The overall incidence of HE was 41% (114/279). Multivariate analysis showed an increased odds for HE in patients with: >3 treatments with transcatheter arterial chemoembolization (TACE) and/or trans-arterial embolization (TAE) (odds ratio [OR], 4.078; 95% confidence interval [95%CI], 1.748-9.515); hepatopetal portal flow (OR, 2.362; 95%CI, 1.032-5.404); high portosystemic pressure gradient (OR, 1.198; 95%CI, 1.073-1.336) and high pre-TIPS MELD score (OR, 1.693; 95%CI, 1.390-2.062). Odds for HE were increased 1.693 fold for each 1-point increase in the MELD score, and 1.198 fold for each 1-mmHg decrease in the post-TIPS portosystemic pressure gradient. Conclusion: The identification of clinical variables associated with increased odds of HE may be useful for the selection of appropriate candidates for TIPS. Results suggest that an inappropriate decrease in the portosystemic pressure gradient might be associated with HE after TIPS. In addition, >3 treatments with TACE/TAE, hepatopetal portal flow, and high MELD score were also associated with increased odds of HE after TIPS. Key words:  –  –  – .

Transjugular Intrahepatic Portosystemic Shunt (TIPS)

2013 ◽  
Vol 06 (01) ◽  
pp. 59-62
Author(s):  
Komgrit Tanisaro ◽  
Chirotchana Suchato ◽  
Rergchai Varatorn
Keyword(s):  
Transjugular Intrahepatic Portosystemic Shunt ◽  
Portosystemic Shunt ◽  
Intrahepatic Portosystemic Shunt
Sign in / Sign up

Export Citation Format

Share Document