Transjugular intrahepatic portosystemic shunt creation for cirrhotic portal hypertension is well tolerated among patients with portal vein thrombosis

J. Merola
B. E. Fortune
Y. Deng
M. Ciarleglio
S. Amirbekian
N. Chaudhary
A. Shanbhogue
R. Ayyagari
M. I. Rodriguez-Davalos
L. Teperman, Zucker School of Medicine at Hofstra/Northwell
H. W. Charles
S. H. Sigal

Abstract

© Copyright 2018 Wolters Kluwer Health, Inc. All rights reserved. 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.