A comparison of transjugular intrahepatic portal-systemic shunt in the treatment of hepatitis B cirrhosis with or without portal vein thrombosis

Abstract

Abstract: Objective To explore the efficacy of transjugular intrahepatic portal-systemic shunt (TIPS) in patients with hepatitis B cirrhosis with or without portal vein thrombosis (PVT). Methods A total of 203 patients with hepatitis B cirrhosis who were successfully treated with TIPS between January 2019 and December 2022 were selected, including 72 patients with PVT and 131 patients without PVT. Data were collected to assess the mortality, shunt dysfunction, and complication rates between these two groups of patients after TIPS operation. Results In PVT group, the platelet count (PLT), hemoglobin (Hb) and total bilirubin levels were (107.2±32.4)×10⁹/L, (76.4±21.7)g/L and (24.6±6.5)mg/dL, respectively, which were statistically different from those of [(65.4±17.7)×10⁹/L, (84.2±26.2)g/L and (33.2±8.4)mg/dL] in the PVT group (P<0.05). A total of twenty-one patients (10.3%) died during follow-up. The causes of death included liver failure (8 cases, 3.9%), multiple organ failure (6 cases, 2.9%), gastrointestinal bleeding (2 cases, 0.9%), hepatorenal syndrome (1 case, 0.5%), sepsis (1 case, 0.5%), cerebral hemorrhage (1 case, 0.5%) and other diseases (2 cases, 0.9%). The cumulative mortality rates of PVT group and non-PVT group at 90 days were 2.6% and 7.5%, and the difference was not statistically significant (P>0.05). The cumulative mortality rates of PVT group and non-PVT group during the whole follow-up period were 10.3% and 16.4%, respectively, without statistical significant difference (P>0.05). There was a statistical difference between PVT group and non-PVT group in varicose bleeding (esophagus and stomach), which was the main indication of TIPS (P<0.05). The main complications of TIPS, the recurrence of varicose bleeding and the recurrence of ascites were similar, but there were significant differences between the two groups in obvious hepatic encephalopathy (P<0.05). During the follow-up period, the cumulative incidence of shunt dysfunction between the two groups was significantly different (P<0.05). Conclusion TIPS is feasible in the treatment of cirrhosis with PVT. Compared with the PVT group, there were no significant differences in the incidence of variceal bleeding and recurrent ascites, but significant differences existed in the incidence of hepatic encephalopathy and shunt dysfunction in patients of the non-PVT group. TIPS represent a potentially viable treatment option for patients with PVT cirrhosis.

Key words: Transjugular intrahepatic portosystemic shunt, Portal vein thrombosis, Cirrhosis

YI Yan-rong, SHEN Yue-ming, WANG Sai, PENG Xiong-qun, PENG Yu. A comparison of transjugular intrahepatic portal-systemic shunt in the treatment of hepatitis B cirrhosis with or without portal vein thrombosis[J]. Chinese Hepatolgy, 2023, 28(4): 448-451.

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