Hepatology (Baltimore, Md.) · 2025
End-procedural adherence to recommended hemodynamic targets does not improve the outcome of elective TIPS in patients with cirrhosis.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Roccarina Davide, Saltini Dario, Adotti Valentina, Rosi Martina, Senzolo Marco, Nardelli Silvia, Bianchini Marcello, Biribin Lara, Caporali Cristian, Margherita Falcini, Ragozzino Lucia, Guasconi Tomas, Casari Federico, Gioia Stefania, Campani Claudia, Prampolini Francesco, Ingravallo Angelica, Gitto Stefano, Aspite Silvia, Arena Umberto, Citone Michele, Gaggini Melania, Ridola Lorenzo, Barbiero Giulio, De Masi Salvatore, Riggio Oliviero, Merli Manuela, Fanelli Fabrizio, Montagnese Sara, Marra Fabio, Schepis Filippo, Vizzutti Francesco
Аннотация
BACKGROUND AND AIMS: In clinical practice, the reduction of portocaval pressure gradient (PCPG) following TIPS does not always meet the recommendation of current guidance. We evaluated the impact of different degrees of PCPG reduction, measured at the end of an elective TIPS, on ascites control, recurrence of portal hypertension-related bleeding (PHRB), and survival.
APPROACH AND RESULTS: Patients with cirrhosis receiving TIPS for refractory ascites (RA) or for the secondary prophylaxis of PHRB were consecutively enrolled. Reduction in PCPG was defined as inadequate hemodynamic response (IHR) in patients not achieving a PCPG <12 mm Hg for both secondary prophylaxis of PHRB and RA, or a reduction of at least 50% only for PHRB. Four hundred fifteen patients were analyzed. An adequate hemodynamic response (AHR) was achieved in 66%. Fifty percent of patients received an under-dilated (≤7 mm) endoprosthesis. No significant differences between patients with IHR and AHR were observed in rebleeding rate and ascites control, while overt HE was higher in AHR. Regardless of TIPS indication, survival was not significantly different between IHR and AHR, while advanced age and liver function before TIPS were significantly associated with a higher cumulative incidence of liver-related death. Notably, in patients with RA the cumulative incidence of liver-related mortality was higher when AHR was defined as a post-TIPS PCPG <12 mm Hg or a reduction ≥50%.
CONCLUSIONS: AHR measured at the end of an elective TIPS may not be essential to define the eventual outcome, while a marked drop in PCPG could negatively affect the prognosis of patients with RA.
APPROACH AND RESULTS: Patients with cirrhosis receiving TIPS for refractory ascites (RA) or for the secondary prophylaxis of PHRB were consecutively enrolled. Reduction in PCPG was defined as inadequate hemodynamic response (IHR) in patients not achieving a PCPG <12 mm Hg for both secondary prophylaxis of PHRB and RA, or a reduction of at least 50% only for PHRB. Four hundred fifteen patients were analyzed. An adequate hemodynamic response (AHR) was achieved in 66%. Fifty percent of patients received an under-dilated (≤7 mm) endoprosthesis. No significant differences between patients with IHR and AHR were observed in rebleeding rate and ascites control, while overt HE was higher in AHR. Regardless of TIPS indication, survival was not significantly different between IHR and AHR, while advanced age and liver function before TIPS were significantly associated with a higher cumulative incidence of liver-related death. Notably, in patients with RA the cumulative incidence of liver-related mortality was higher when AHR was defined as a post-TIPS PCPG <12 mm Hg or a reduction ≥50%.
CONCLUSIONS: AHR measured at the end of an elective TIPS may not be essential to define the eventual outcome, while a marked drop in PCPG could negatively affect the prognosis of patients with RA.