JOURNAL ARTICLE
MULTICENTER STUDY

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
European Journal of Gastroenterology & Hepatology 2018, 30 (6): 668-675
29462027

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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