Transjugular intrahepatic portosystemic shunt creation for cirrhotic portal hypertension is well tolerated among patients with portal vein thrombosis

Jonathan Merola, Brett E. Fortune, Yanhong Deng, Maria Ciarleglio, Smbat Amirbekian, Noami Chaudhary, Alampady Shanbhogue, Rajasekhara Ayyagari, Manuel I. Rodriguez-Davalos, Lewis Teperman, Hearns W. Charles, Samuel H. Sigal

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background Portal vein thrombosis (PVT) develops in cirrhotic patients because of stagnation of blood flow. Transjugular intrahepatic portosystemic shunt (TIPS) creates a low-resistance conduit that restores portal venous patency and blood flow. Aim The effect of PVT on transplant-free survival in cirrhotic patients undergoing TIPS creation was evaluated. Patients and methods A multicenter, retrospective cohort study of patients who underwent TIPS creation for cirrhotic portal hypertension was carried out. A Cox model with propensity score adjustment was developed to evaluate the effect of PVT on 90-day and 3-year transplant-free survival. A subgroup analysis examining mortality of those with superior and inferior PVT was also carried out. Results A total of 252 consecutive TIPS creations were assessed, including 65 in patients with PVT. Survival of patients with high Model for End-stage Liver Disease scores (≥18) and PVT was not statistically different compared with patients with low Model for End-stage Liver Disease scores (<18) and no PVT at 90 days (P= 0.46) and 3 years (P=0.42). Those with superior PVT had improved 90-day and 3-year survival both compared with patients with a inferior PVT and those without a PVT (P <0.01, all cases). Conclusion The presence of PVT does not impair the prognosis of patients following TIPS creation, particularly in patients with superior portal occlusion.

Original languageEnglish (US)
Pages (from-to)668-675
Number of pages8
JournalEuropean Journal of Gastroenterology and Hepatology
Volume30
Issue number6
DOIs
StatePublished - Jan 1 2018

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Transjugular Intrahepatic Portasystemic Shunt
Portal Hypertension
Portal Vein
Thrombosis
End Stage Liver Disease
Survival
Transplants
Propensity Score
Proportional Hazards Models
Cohort Studies
Retrospective Studies

Keywords

  • cirrhosis
  • coagulopathy
  • mortality
  • variceal bleeding

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Transjugular intrahepatic portosystemic shunt creation for cirrhotic portal hypertension is well tolerated among patients with portal vein thrombosis. / Merola, Jonathan; Fortune, Brett E.; Deng, Yanhong; Ciarleglio, Maria; Amirbekian, Smbat; Chaudhary, Noami; Shanbhogue, Alampady; Ayyagari, Rajasekhara; Rodriguez-Davalos, Manuel I.; Teperman, Lewis; Charles, Hearns W.; Sigal, Samuel H.

In: European Journal of Gastroenterology and Hepatology, Vol. 30, No. 6, 01.01.2018, p. 668-675.

Research output: Contribution to journalArticle

Merola, J, Fortune, BE, Deng, Y, Ciarleglio, M, Amirbekian, S, Chaudhary, N, Shanbhogue, A, Ayyagari, R, Rodriguez-Davalos, MI, Teperman, L, Charles, HW & Sigal, SH 2018, 'Transjugular intrahepatic portosystemic shunt creation for cirrhotic portal hypertension is well tolerated among patients with portal vein thrombosis', European Journal of Gastroenterology and Hepatology, vol. 30, no. 6, pp. 668-675. https://doi.org/10.1097/MEG.0000000000001097
Merola, Jonathan ; Fortune, Brett E. ; Deng, Yanhong ; Ciarleglio, Maria ; Amirbekian, Smbat ; Chaudhary, Noami ; Shanbhogue, Alampady ; Ayyagari, Rajasekhara ; Rodriguez-Davalos, Manuel I. ; Teperman, Lewis ; Charles, Hearns W. ; Sigal, Samuel H. / Transjugular intrahepatic portosystemic shunt creation for cirrhotic portal hypertension is well tolerated among patients with portal vein thrombosis. In: European Journal of Gastroenterology and Hepatology. 2018 ; Vol. 30, No. 6. pp. 668-675.
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AU - Merola, Jonathan

AU - Fortune, Brett E.

AU - Deng, Yanhong

AU - Ciarleglio, Maria

AU - Amirbekian, Smbat

AU - Chaudhary, Noami

AU - Shanbhogue, Alampady

AU - Ayyagari, Rajasekhara

AU - Rodriguez-Davalos, Manuel I.

AU - Teperman, Lewis

AU - Charles, Hearns W.

AU - Sigal, Samuel H.

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N2 - Background Portal vein thrombosis (PVT) develops in cirrhotic patients because of stagnation of blood flow. Transjugular intrahepatic portosystemic shunt (TIPS) creates a low-resistance conduit that restores portal venous patency and blood flow. Aim The effect of PVT on transplant-free survival in cirrhotic patients undergoing TIPS creation was evaluated. Patients and methods A multicenter, retrospective cohort study of patients who underwent TIPS creation for cirrhotic portal hypertension was carried out. A Cox model with propensity score adjustment was developed to evaluate the effect of PVT on 90-day and 3-year transplant-free survival. A subgroup analysis examining mortality of those with superior and inferior PVT was also carried out. Results A total of 252 consecutive TIPS creations were assessed, including 65 in patients with PVT. Survival of patients with high Model for End-stage Liver Disease scores (≥18) and PVT was not statistically different compared with patients with low Model for End-stage Liver Disease scores (<18) and no PVT at 90 days (P= 0.46) and 3 years (P=0.42). Those with superior PVT had improved 90-day and 3-year survival both compared with patients with a inferior PVT and those without a PVT (P <0.01, all cases). Conclusion The presence of PVT does not impair the prognosis of patients following TIPS creation, particularly in patients with superior portal occlusion.

AB - Background Portal vein thrombosis (PVT) develops in cirrhotic patients because of stagnation of blood flow. Transjugular intrahepatic portosystemic shunt (TIPS) creates a low-resistance conduit that restores portal venous patency and blood flow. Aim The effect of PVT on transplant-free survival in cirrhotic patients undergoing TIPS creation was evaluated. Patients and methods A multicenter, retrospective cohort study of patients who underwent TIPS creation for cirrhotic portal hypertension was carried out. A Cox model with propensity score adjustment was developed to evaluate the effect of PVT on 90-day and 3-year transplant-free survival. A subgroup analysis examining mortality of those with superior and inferior PVT was also carried out. Results A total of 252 consecutive TIPS creations were assessed, including 65 in patients with PVT. Survival of patients with high Model for End-stage Liver Disease scores (≥18) and PVT was not statistically different compared with patients with low Model for End-stage Liver Disease scores (<18) and no PVT at 90 days (P= 0.46) and 3 years (P=0.42). Those with superior PVT had improved 90-day and 3-year survival both compared with patients with a inferior PVT and those without a PVT (P <0.01, all cases). Conclusion The presence of PVT does not impair the prognosis of patients following TIPS creation, particularly in patients with superior portal occlusion.

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