Does Transjugular Intrahepatic Portosystemic Shunt Stent Differentially Improve Survival in a Subset of Cirrhotic Patients?

Seminars in Liver Disease
Jonel Trebicka

Abstract

Does transjugular intrahepatic portosystemic shunt stent (TIPS) improve survival in a subgroup of patients? Yes. TIPS nearly halves portal pressure and increases the effective blood volume. In cases of acute variceal hemorrhage and with a high risk of treatment failure, defined as either hepatic venous pressure gradient higher than 20 mm Hg, Child B with active bleeding at the endoscopy, or Child C with less than 14 points, early or preemptive placement of TIPS (within 72 hours) improves survival. Also, in suitable patients with intractable or refractory ascites, TIPS improves survival if placed early in the course of treatment. While TIPS does not improve survival in other situations, it improves disease management, especially in patients without TIPS contraindications but with refractory bleeding, early rebleeding, portal vein thrombosis, and hepatorenal syndrome. Experience gained at the centers and follow-up of TIPS patients are key features that improve outcome. Important factors for selection and follow-up include cardiac function, inflammation, sarcopenia, age, and early evaluation for liver transplantation.

Citations

Mar 29, 2019·Alimentary Pharmacology & Therapeutics·Christian Jansen, Jonel Trebicka
May 20, 2020·The American Journal of Gastroenterology·Sammy SaabEdward Wolfgang Lee
Oct 23, 2018·Visceral Medicine·Jonel TrebickaWim Laleman
Aug 27, 2019·Liver International : Official Journal of the International Association for the Study of the Liver·Maria TornerJonel Trebicka
Jul 25, 2020·Hepatology : Official Journal of the American Association for the Study of Liver Diseases·Yong LvGuohong Han
Sep 28, 2020·Gastroenterology·Oana Nicoară-FarcăuUNKNOWN Preemptive TIPS Individual Data Metanalysis, International Variceal Bleeding Study and Baveno Cooperation Study groups
Aug 3, 2021·JHEP Reports : Innovation in Hepatology·Yasuko Iwakiri, Jonel Trebicka

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