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Role of the transjugular intrahepatic portosystemic shunt in the management of severe complications of portal hypertension in idiopathic noncirrhotic portal hypertension
Author(s) -
Bissonnette Julien,
GarciaPagán Juan Carlos,
Albillos Agustín,
Turon Fanny,
Ferreira Carlos,
Tellez Luis,
Nault JeanCharles,
Carbonell Nicolas,
Cervoni JeanPaul,
Abdel Rehim Mohamed,
Sibert Annie,
Bouchard Louis,
Perreault Pierre,
Trebicka Jonel,
TrottierTellier Félix,
Rautou PierreEmmanuel,
Valla DominiqueCharles,
Plessier Aurélie
Publication year - 2016
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.28547
Subject(s) - medicine , portal hypertension , transjugular intrahepatic portosystemic shunt , ascites , gastroenterology , cirrhosis , hepatic encephalopathy , liver disease , creatinine , surgery
Idiopathic noncirrhotic portal hypertension is a heterogeneous group of diseases characterized by portal hypertension in the absence of cirrhosis. The efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) in this population are unknown. The charts of patients with idiopathic noncirrhotic portal hypertension undergoing TIPS in seven centers between 2000 and 2014 were retrospectively reviewed. Forty‐one patients were included. Indications for TIPS were recurrent variceal bleeding (n = 25) and refractory ascites (n = 16). Patients were categorized according to the presence (n = 27) or absence (n = 14) of significant extrahepatic comorbidities. Associated conditions were hematologic, prothrombotic, neoplastic, immune, and exposure to toxins. During follow‐up (mean 27 ± 29 months), variceal rebleeding occurred in 7/25 (28%), including three with early thrombosis of the stent. Post‐TIPS overt hepatic encephalopathy was present in 14 patients (34%). Eleven patients died, five due the liver disease or complications of the procedure and six because of the associated comorbidities. The procedure was complicated by hemoperitoneum in four patients (10%), which was fatal in one case. Serum creatinine ( P = 0.005), ascites as indication for TIPS ( P = 0.04), and the presence of significant comorbidities ( P = 0.01) at the time of the procedure were associated with death. Mortality was higher in patients with significant comorbidities and creatinine ≥100 μmol/L ( P < 0.001). Conclusion : In patients with idiopathic noncirrhotic portal hypertension who have normal kidney function or do not have severe extrahepatic conditions, TIPS is an excellent option to treat severe complications of portal hypertension. (H epatology 2016;64:224–231)