Long-term clinical outcome and survival predictors in patients with cirrhosis after 10-mm-covered transjugular intrahepatic portosystemic shunt

Autor: Gloria Sánchez-Antolín, Elena Villacastín-Ruiz, Esteban Fuentes-Valenzuela, Fátima Sánchez-Martín, Rodrigo Nájera-Muñoz, Hermógenes Calero-Aguilar, Carolina Almohalla-Álvarez, Rebeca Pintado-Garrido, Félix García-Pajares, Javier Tejedor-Tejada
Rok vydání: 2021
Předmět:
Adult
Liver Cirrhosis
Male
medicine.medical_specialty
Cirrhosis
medicine.medical_treatment
Hydrothorax
Kaplan-Meier Estimate
Hepatic Veins
Esophageal and Gastric Varices
Prosthesis Design
Gastroenterology
030218 nuclear medicine & medical imaging
03 medical and health sciences
0302 clinical medicine
Postoperative Complications
Internal medicine
Hypertension
Portal
medicine
Humans
In patient
Renal Insufficiency
Hepatic encephalopathy
Polytetrafluoroethylene
Serum Albumin
Aged
Proportional Hazards Models
Retrospective Studies
Aged
80 and over
Hepatology
business.industry
Proportional hazards model
Sodium
Stent
Ascites
Middle Aged
medicine.disease
Treatment Outcome
Hepatic Encephalopathy
Portal hypertension
030211 gastroenterology & hepatology
Female
Stents
Refractory ascites
Portasystemic Shunt
Transjugular Intrahepatic
business
Gastrointestinal Hemorrhage
Transjugular intrahepatic portosystemic shunt
Zdroj: Gastroenterología y Hepatología (English Edition). 44:620-627
ISSN: 2444-3824
DOI: 10.1016/j.gastre.2020.10.006
Popis: Background and aims Transjugular intrahepatic portosystemic shunts (TIPS) are successfully used in the management of portal hypertension (PH)-related complications. Debate surrounds the diameter of the dilation. The aim was to analyse the outcomes of and complications deriving from TIPS in patients with cirrhosis and identify predictors of survival. Methods This was a retrospective single-centre study, which included patients with cirrhosis who had a TIPS procedure for PH from 2009 to October 2018. Demographic, clinical and radiological data were collected. The Kaplan–Meier method was used to measure survival and predictors of survival were identified with the Cox regression model. Results A total of 98 patients were included (78.6% male), mean age was 58.5 (SD±/−9.9) and the median MELD was 13.3 (IQR 9.5–16). The indications were refractory ascites (RA), variceal bleeding (VB) and hepatic hydrothorax (HH). Median survival was 72 months (RA 46.4, VB 68.5 and HH 64.7) and transplant-free survival was 26 months. Clinical and technical success rates were 70.5% and 92.9% respectively. Age (HR 1.05), clinical success (HR 0.33), sodium (HR 0.92), renal failure (HR 2.46) and albumin (HR 0.35) were predictors of survival. Hepatic encephalopathy occurred in 28.6% of patients and TIPS dysfunction occurred in 16.3%. Conclusions TIPS with 10-mm PTFE-covered stent is an effective and safe treatment for PH-related complications in patients with cirrhosis. Age, renal failure, sodium, albumin and clinical success are independent predictors of long-term survival.
Databáze: OpenAIRE
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