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. 2022 Dec;67(12):5693-5703.
doi: 10.1007/s10620-022-07443-6. Epub 2022 Mar 17.

Covered Transjugular Intrahepatic Portosystemic Shunt Improves Hypersplenism-Associated Cytopenia in Cirrhosis

Theresa Bucsics  1   2 , Katharina Lampichler  3 , Constantin Vierziger  4 , Maria Schoder  3 , Florian Wolf  3 , David Bauer  1   2 , Benedikt Simbrunner  1   2   5 , Lukas Hartl  1   2 , Mathias Jachs  1   2 , Bernhard Scheiner  1   2 , Michael Trauner  2 , Thomas Gruenberger  4 , Franz Karnel  6 , Mattias Mandorfer  1   2 , Thomas Reiberger  7   8   9
Affiliations

Covered Transjugular Intrahepatic Portosystemic Shunt Improves Hypersplenism-Associated Cytopenia in Cirrhosis

Theresa Bucsics et al. Dig Dis Sci. 2022 Dec.

Abstract

Background: Patients with cirrhosis often develop portal hypertension-associated splenomegaly and hypersplenism, potentially causing severe cytopenia.

Aims: Systematic assessment on the impact of transjugular intrahepatic portosystemic shunt (TIPS) implantation on platelet count (PLT), hemoglobin (Hb), and white blood cell count (WBC).

Methods: Patients with cirrhosis undergoing covered TIPS implantation were retrospectively included. Patients with malignancies or hematologic disorders were excluded. Hematology lab work was recorded at baseline (pre-TIPS) and at regular intervals after TIPS.

Results: One hundred ninety-two patients (male: 72.4%, age: 56 ± 10 years; MELD: 12.1 ± 3.6) underwent TIPS implantation. Higher-grade (≥ G2) thrombocytopenia (PLT < 100 G/L) was present in 54 (28.7%), ≥ G2 anemia (Hb < 10 g/dL) in 57 (29.7%), and ≥ G2 leukopenia (WBC < 2 G/L) in 3 (1.6%) patients pre-TIPS, respectively. Resolution of ≥ G2 thrombocytopenia, anemia, and leukopenia occurred in 24/55 (43.6%), 23/57 (40.4%), and 2/3 (66.7%), respectively. Similar results were also observed in the subgroup of patients without 'bleeding' TIPS-indication, with improvements of G ≥ 2 thrombocytopenia and of G ≥ 2 anemia in 19.8% and 10.2% of patients after TIPS, respectively.

Conclusions: Thrombocytopenia, anemia, and leukopenia frequently improved after TIPS. Therefore, moderate- to higher-grade thrombocytopenia should not be regarded as a contraindication against TIPS, but rather be considered in case of severe thrombocytopenia-particularly prior to surgery or interventions.

Keywords: Anemia; Cirrhosis; Hypersplenism; Portal hypertension; TIPS; Thrombocytopenia.

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Conflict of interest statement

Mattias Mandorfer served as a speaker and/or consultant and/or advisory board member for W.L. Gore and Associates. Thomas Reiberger received grant support and speaking honoraria from W.L. Gore and Associates. Maria Schoder served as a speaker and/or consultant and/or advisory board member for W.L. Gore and Associates.

Figures

Fig. 1
Fig. 1
Patient Flowchart. Abbreviations: PTFE, polytetrafluoroethylene; TIPS, transjugular intrahepatic portosystemic shunt; HCC, hepatocellular carcinoma; LLN, lower limit of normal; WBC, white blood cell count. Lower Limit of normal (LLN) of hemoglobin: males: 13.5 g/dL, females: 12.5 g/dL
Fig. 2
Fig. 2
Improvement of thrombocytopenia, anemia and leukopenia over time. a, c, e: absolute and b, c, f: relative changes in a, b: platelet count (PLT); c, d: hemoglobin and e, f: white blood cell count (WBC) over time, stratified by severity of the underlying cytopenia. Denotations: *: p < 0.05, **: p < 0.01; ***: p < 0.001
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