Impressive recompensation in transjugular intrahepatic portosystemic shunt-treated individuals with complications of decompensated cirrhosis based on Baveno VII criteria

Abstract

Background: Transjugular intrahepatic portosystemic shunt (TIPS) is the standard second-line treatment option for individuals with complications of decompensated cirrhosis, such as variceal bleeding and refractory ascites.

Aim: To investigate whether recompensation existed in TIPS-treated patients with decompensated cirrhosis according to Baveno VII criteria.

Methods: This retrospective analysis was performed on 64 patients who received TIPS for variceal bleeding or refractory ascites. The definition of recompensation referred to Baveno VII criteria and previous study. Clinical events, laboratory tests, and radiological examinations were regularly conducted during a preset follow-up period. The recompensation ratio in this cohort was calculated. Beyond that, univariate and multivariate regression models were conducted to identify the predictors of recompensation.

Results: Of the 64 patients with a 12-mo follow-up, 20 (31%) achieved recompensation. Age [odds ratio (OR): 1.124; 95% confidence interval (CI): 1.034-1.222] and post-TIPS portal pressure gradient < 12 mmHg (OR: 0.119; 95%CI: 0.024-0.584) were identified as independent predictors of recompensation in patients with decompensated cirrhosis after TIPS.

Conclusion: The present study demonstrated that nearly one-third of the TIPS-treated patients achieved recompensation within this cohort. According to our findings, recompensation is more likely to be achieved in younger patients. In addition, postoperative portal pressure gradient reduction below 12 mmHg contributes to the occurrence of recompensation.

Keywords: Cirrhosis recompensation; Complications; Liver cirrhosis; Portal hypertension; Predictors; Transjugular intrahepatic portosystemic shunt.

Figure 1

Flow chart of patient inclusion. TIPS: Transjugular intrahepatic portosystemic shunt.

Figure 2

Dynamic changes of major laboratory test parameters and Child-Pugh/model for end-stage liver disease scores during the 12-mo follow-up. A: Alanine aminotransferase; B: Aspartate aminotransferase; C: Albumin; D: Total bilirubin; E: Creatinine; F: Platelets; G: International normalized ratio; H: Child-Pugh score; I: Model for end-stage liver disease score. ^aP < 0.05. BL: Baseline; 3D: Postoperative day 3; 1M: One month postoperatively; 3M: Three months postoperatively; 6M: Six months postoperatively; 12M: Twelve months postoperatively; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; ALB: Albumin; TBIL: Total bilirubin; CR: Creatinine; PLT: Platelets; INR: International normalized ratio; MELD: Model for end-stage liver disease.

Figure 3

Dynamic changes in abdominal ultrasound measurement results during the 12-mo follow-up. A: Portal vein inner diameter; B: Portal vein velocity; C: Liver sound touch quantification; D: Spleen sound touch quantification; E: Spleen length; F: Spleen volume. ^aP < 0.05. BL: Baseline; 3D: Postoperative day 3; 1M: One month postoperatively; 3M: Three months postoperatively; 6M: Six months postoperatively; 12M: Twelve months postoperatively; PVD: Portal vein inner diameter; PVV: Portal vein velocity; LSTQ: Liver sound touch quantification; SSTQ: Spleen sound touch quantification; SL: Spleen length; SV: Spleen volume.

Figure 4

Dynamic changes of liver function classification in patients with and without recompensation during the 12-mo follow-up. A and B: Mean Child-Pugh/model for end-stage liver disease (MELD) scores at baseline (BL) and follow-up in patients with or without recompensation (bars represent standard error of the mean). The differences in Child-Pugh/MELD scores in these two groups at each time point were compared using the Student’s t-test. The difference in Child-Pugh/MELD scores between BL and 12 mo after transjugular intrahepatic portosystemic shunt was compared separately for each group. Sankey diagrams were used to show the major transfers or flows of patients. The colors of the columns represent patients with different Child-Pugh classifications, with red representing Child-Pugh A, green representing Child-Pugh B, and blue representing Child-Pugh C. The length of the column represents the proportion of patients. The thicker the line, the greater the number of patients involved; C: Entire cohort (n = 64); D: Patients with recompensation (n = 20); E: Patients without recompensation (n = 44). BL: Baseline; 3D: Postoperative day 3; 1M: One month postoperatively; 3M: Three months postoperatively; 6M: Six months postoperatively; 12M: Twelve months postoperatively.

Figure 5

Univariate and multivariate logistic regression analysis identified independent predictors of recompensation after transjugular intrahepatic portosystemic shunt. A: Univariate logistic regression analysis; B: Multivariate logistic regression analysis. Age and post-transjugular intrahepatic portosystemic shunt portosystemic pressure gradient < 12 mmHg could be identified as independent predictors of recompensation. All parameters with a P value < 0.1 in the univariate analysis were included in the multivariate logistic regression analysis. CI: Confidence interval; TIPS: Transjugular intrahepatic portosystemic shunt; OR: Odds ratio; PPG: Portosystemic pressure gradient; TBIL: Total bilirubin.