scholarly journals Portal pressure gradient and serum albumin: A simple combined parameter associated with the appearance of ascites in decompensated cirrhosis treated with transjugular intrahepatic portosystemic shunt

2019 ◽  
Vol 25 (2) ◽  
pp. 210-217
Author(s):  
Dongmei Zhao ◽  
Guobing Zhang ◽  
Mingquan Wang ◽  
Chaoxue Zhang ◽  
Jiabin Li
Keyword(s):  
Serum Albumin ◽  
Pressure Gradient ◽  
Transjugular Intrahepatic Portosystemic Shunt ◽  
Portal Pressure ◽  
Portosystemic Shunt ◽  
Decompensated Cirrhosis ◽  
Intrahepatic Portosystemic Shunt

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:  –  –  – .

scholarly journals Rapid change of liver stiffness after variceal ligation and TIPS implantation

2018 ◽  
Vol 314 (2) ◽  
pp. G179-G187 ◽  
Author(s):  
Felix Piecha ◽  
Daniel Paech ◽  
Janina Sollors ◽  
Helmut-Karl Seitz ◽  
Martin Rössle ◽  
...  
Keyword(s):  
Transjugular Intrahepatic Portosystemic Shunt ◽  
Esophageal Varices ◽  
Wistar Rats ◽  
Venous Pressure ◽  
Portal Pressure ◽  
Liver Stiffness ◽  
Portosystemic Shunt ◽  
Central Venous ◽  
Intrahepatic Portosystemic Shunt ◽  
Pressure Changes

Liver stiffness (LS) as measured by transient elastography is widely used to screen for liver fibrosis. However, LS also increases in response to pressure changes like congestion but no data on portal pressure are available. We study here the effect of rapid portal pressure changes on LS. Therefore, LS was assessed directly prior and after ligation of esophageal varices ( n = 11) as well as transjugular intrahepatic portosystemic shunt (TIPS) implantation in patients with established cirrhosis ( n = 14). Additionally, we retrospectively analyzed changes in LS and variceal size in patients with sequential gastroscopic monitoring and LS measurements ( n = 14). To study LS and portal pressure in healthy livers, LS (µFibroscan; Echosens, Paris, France) and invasive pressures (Powerlab, AD Instruments, New Zealand) were assessed in male Wistar rats after ligation of single liver lobes. Ligation of esophageal varices caused an immediate and significant increase of LS from 40.3 ± 19.0 to 56.1 ± 21.5 kPa. Likewise, LS decreased significantly from 53.1 ± 16.6 to 43.8 ± 17.3 kPa after TIPS placement, which correlated significantly with portal pressure ( r = 0.558). In the retrospective cohort, the significant LS decrease from 54.9 ± 23.5 to 47.9 ± 23.8 kPa over a mean observation interval of 4.3 ± 3 mo was significantly correlated with a concomitant increase of variceal size ( r = −0.605). In the animal model, LS and portal pressure increased significantly after single lobe ligation without changes of arterial or central venous pressure. In conclusion, rapid changes of portal pressure are a strong modulator of LS in healthy and cirrhotic organs. In patients with stable cirrhosis according to the model for end-stage liver disease (MELD), a decrease of LS may be indicative for enlarging varices. NEW & NOTEWORTHY Liver stiffness (LS) immediately increases after variceal ligation while it decreases after transjugular intrahepatic portosystemic shunt (TIPS) implantation due to portal pressure changes. LS and portal pressure rapidly increase after single lobe ligation in Wistar rats without changes of arterial or central venous pressure. Collateral formation may be one cause for a transient decrease in LS in the absence of other confounders. Such pressure changes should be considered when interpreting LS in clinical practice.

Early Transjugular Intrahepatic Portosystemic Shunt (TIPS) Placement in Patients with Cirrhosis and Variceal Bleeding

2017 ◽  
Vol 01 (04) ◽  
pp. 272-276 ◽  
Author(s):  
Brett Fortune ◽  
Mark Sands ◽  
Maria Bayona-Molano ◽  
Baljendra Kapoor ◽  
Min Lang
Keyword(s):  
Transjugular Intrahepatic Portosystemic Shunt ◽  
Variceal Bleeding ◽  
Portosystemic Shunt ◽  
Decompensated Cirrhosis ◽  
Proper Patient Selection ◽  
Rescue Treatment ◽  
Increased Risk ◽  
Intrahepatic Portosystemic Shunt ◽  
Pugh Class ◽  
Early Tips

AbstractThe placement of a transjugular intrahepatic portosystemic shunt (TIPS) has been traditionally used as a rescue treatment for uncontrolled or recurrent acute variceal bleeding (AVB) in patients with cirrhosis. However, more contemporary studies are revealing that early or ‘pre-emptive’ TIPS placement (performed within 24–72 h of AVB presentation) significantly controls bleeding, prevents rebleeding, and improves survival in selected patients when compared with standard pharmacological and endoscopic therapies. Furthermore, the use of early TIPS did not translate to an increased risk of hepatic encephalopathy (HE) for this population. Proper patient selection for early TIPS is paramount, as the procedure is unlikely to benefit patients with advanced decompensated cirrhosis (Child–Turcotte–Pugh [CTP] class C, score > 13) or patients who do not carry high risk with only mild hepatic dysfunction (Child-Turcotte-Pugh class A). Finally, while the current results for early TIPS are promising, further prospective studies are needed to confirm these findings before early TIPS can be widely adopted.

scholarly journals Rethink Your Transjugular Intrahepatic Portosystemic Shunt (TIPS): Pre-TIPS Infection Predicts Post-TIPS Infection and Post-TIPS Portosystemic Encephalopathy

2020 ◽  
pp. 34-41
Author(s):  
Jenna Koblinski ◽  
Margaret C. Liu ◽  
Roy U. Bisht ◽  
Paul Kang ◽  
Mark Wong ◽  
...  
Keyword(s):  
Transjugular Intrahepatic Portosystemic Shunt ◽  
Odds Ratio ◽  
Portal Pressure ◽  
Retrospective Chart Review ◽  
Portosystemic Shunt ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Exact Test ◽  
Portosystemic Encephalopathy ◽  
Intrahepatic Portosystemic Shunt

Abstract Objective: Transjugular intrahepatic portosystemic shunt (TIPS) is used for decompression of elevated portal pressure; however, there are potential complications. The aim of this study was to compare the risk of complications of TIPS in those who had an episode of infection within 6 months prior to TIPS to those without an infection prior. Methods: A retrospective chart review was performed on patients who underwent TIPS at a single transplant centre over 8 years. They were divided into two groups: patients without infection during the 6 months prior to TIPS (n=349) and those with an infection prior (bacterial/fungal) (n=53). The Wilcoxon rank-sum test was used to compare continuous variables while chi-squared analysis and Fisher’s exact test was used for categorical variables. Multiple logistic regression was used to ascertain the association between pre-TIPS infection status and likelihood of post-TIPS infection. Results: In the group of patients who had an infection before TIPS, 26.4% (n=14) had an episode of infection after the procedure, while in the group without infection prior, 16.2% (n=55) had an infection after the procedure (p=0.047; odds ratio: 2.08). In the pre-TIPS infection group, 54.7% (n=29) had an episode of portosystemic encephalopathy post-TIPS versus 39.6% (n=134) in the group without infection before TIPS (p=0.046; odds ratio: 1.93). Conclusion: Pre-TIPS infection within 6 months of TIPS procedure is a risk factor for post-TIPS portosystemic encephalopathy and infection. Further studies are needed to determine the potential benefit of antibiotic prophylaxis in patients who had an infection in the 6 months preceding TIPS placement.

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