Relationship between pre-TIPS liver perfusion by the portal vein and the incidence of post-TIPS chronic hepatic encephalopathy.

Abstract

OBJECTIVE:

In the present study we evaluated the predictive value of pretransjugular intrahepatic portosystemic shunt (TIPS) portal perfusion as assessed by Doppler ultrasonography for the onset of chronic encephalopathy after TIPS.

METHODS:

A total of 231 cirrhotic patients were followed-up prospectively after TIPS placement. The pattern of intrahepatic portal flow was assessed before TIPS. Patients were divided into two groups according to Doppler findings. Group 1 comprised patients with prograde portal flow (n = 200), whereas group 2 comprised those with loss of portal perfusion (hepatofugal or back-and-forth flow or portal vein thrombosis; n = 31). The presence of chronic encephalopathy during a median follow-up of 32 months was prospectively recorded. The prognostic value of the following parameters for the onset of chronic recurrent encephalopathy after TIPS was evaluated: age, presence of encephalopathy before TIPS, alcoholism, Pugh score, and loss of portal perfusion before TIPS. The independent prognostic value of each variable was tested with a multiple logistic regression analysis.

RESULTS:

The two groups were comparable in terms of age, incidence of prior episodes of hepatic encephalopathy, and portacaval gradient before and after the procedure; however, liver failure was more severe in patients in group 2 (Pugh score: 9.2 +/- 1.9 vs 10.3 +/- 1.7). The 3-yr survival was identical for both groups; 25% of the 200 patients in group 1 developed chronic encephalopathy as compared to 6% of the 31 patients in group 2 (p = 0.03). Multiple logistic regression analysis demonstrated that loss of portal perfusion and age >65 yr were the only independent predictors of the onset of post-TIPS chronic encephalopathy (odds ratios 0.24 and 1.98, respectively).

CONCLUSIONS:

Cirrhotic patients with loss of portal perfusion before TIPS were protected against post-TIPS chronic hepatic encephalopathy despite a more severe liver dysfunction at baseline. The only other independent predictive factor for the onset of this complication was age.

• Authors: Z Hassoun, M Deschênes, M Lafortune, M P Dufresne, P Perreault, L Lepanto, D Gianfelice, B Bui, G Pomier-Layrargues
• Journal: The American journal of gastroenterology (Am J Gastroenterol) Vol. 96 Issue 4 Pg. 1205-9 (Apr 2001) ISSN: 0002-9270 [Print] United States
• PMID: 11316171 (Publication Type: Journal Article)

Topics

• Adult
• Aged
• Aged, 80 and over
• Female
• Follow-Up Studies
• Hepatic Encephalopathy (diagnostic imaging, etiology, physiopathology)
• Humans
• Liver Circulation
• Liver Cirrhosis (physiopathology, surgery)
• Male
• Middle Aged
• Portal Vein
• Portasystemic Shunt, Transjugular Intrahepatic (adverse effects)
• Predictive Value of Tests
• Prospective Studies
• Ultrasonography, Doppler