Wiener klinische Wochenschrift · 2025
Effectiveness of controlled-expansion transjugular intrahepatic portosystemic shunt (CX-TIPS) in an interdisciplinary setting at a large tertiary center.
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Hintersteininger Marlene, Kappel Julia, Müllner-Buscics Theresa, Riegler Susanna, Dominik Nina, Kramer Georg, Sebesta Christian, Thöne Paul, Stättermayer Albert Friedrich, Reider Lukas, Schoder Maria, Klausenitz Catharina, Varga Raoul, Waneck Fredrik, Trauner Michael, Mandorfer Mattias, Reiberger Thomas, Hartl Lukas
Аннотация
INTRODUCTION: The use of controlled-expansion transjugular intrahepatic portosystemic shunt (CX-TIPS) effectively controls portal hypertension (PH)-related complications while reducing risks related to fully expanded stents. We evaluated the effectiveness of CX-TIPS in a large Viennese patient cohort.
METHOD: We assessed the number of patients evaluated for CX-TIPS placement by interdisciplinary discussion at the Medical University of Vienna and included all patients from the prospective AUTIPS registry undergoing CX-TIPS placement between June 2018 - December 2024. After clinical and laboratory characterization at baseline, patients were followed up for clinical events.
RESULTS: Overall, 200 patients underwent interdisciplinary evaluation for CX-TIPS. In 62.5% CX-TIPS was recommended and 82.4% of these patients underwent CX-TIPS placement. Among 103 patients with CX-TIPS placement between June 2018 - December 2024 (median age 57 years, 67.0% male, median MELD 11), the primary indication for CX-TIPS implantation was ascites (65.0%). The median portal pressure gradient decreased from 18 mm Hg to 8 mm Hg after CX-TIPS. Underdilated CX-TIPS placement was performed in 13.6% (n = 14) of patients and portal vein recanalization (PVR-TIPS) was performed in 4 patients. During a median follow-up time of 13.5 months, 30.1% of patients experienced hepatic encephalopathy and 5.8% cardiac decompensation. Kaplan-Meier survival analyses revealed 1‑year and 3‑year transplant-free survival rates of 78.0% and 74.7%, respectively.
CONCLUSION: Implementation of interdisciplinary case discussions and the use of CX-TIPS enable personalized medicine in patients with cirrhosis. Underdilation of CX-TIPS should be considered in patients at high risk for complications.
METHOD: We assessed the number of patients evaluated for CX-TIPS placement by interdisciplinary discussion at the Medical University of Vienna and included all patients from the prospective AUTIPS registry undergoing CX-TIPS placement between June 2018 - December 2024. After clinical and laboratory characterization at baseline, patients were followed up for clinical events.
RESULTS: Overall, 200 patients underwent interdisciplinary evaluation for CX-TIPS. In 62.5% CX-TIPS was recommended and 82.4% of these patients underwent CX-TIPS placement. Among 103 patients with CX-TIPS placement between June 2018 - December 2024 (median age 57 years, 67.0% male, median MELD 11), the primary indication for CX-TIPS implantation was ascites (65.0%). The median portal pressure gradient decreased from 18 mm Hg to 8 mm Hg after CX-TIPS. Underdilated CX-TIPS placement was performed in 13.6% (n = 14) of patients and portal vein recanalization (PVR-TIPS) was performed in 4 patients. During a median follow-up time of 13.5 months, 30.1% of patients experienced hepatic encephalopathy and 5.8% cardiac decompensation. Kaplan-Meier survival analyses revealed 1‑year and 3‑year transplant-free survival rates of 78.0% and 74.7%, respectively.
CONCLUSION: Implementation of interdisciplinary case discussions and the use of CX-TIPS enable personalized medicine in patients with cirrhosis. Underdilation of CX-TIPS should be considered in patients at high risk for complications.