Recompensation after TIPS reduces the incidence of hepatocellular carcinoma and increases survival in patients with cirrhosis

IF 6 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Liver International Pub Date : 2024-09-02 DOI:10.1111/liv.16095

José Sánchez, Sheila González, Paloma Poyatos, María Desamparados Escudero, Cristina Montón, Juan-Antonio Carbonell, Elisabetta Casula, Jorge Guijarro, Paloma Lluch, María Pilar Ballester

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引用次数: 0

Abstract

Background and Aims

It has been described that recompensation can improve prognosis in patients with cirrhosis. However, recompensation after transjugular intrahepatic portosystemic shunt (TIPS) has not been studied. We evaluated the impact of recompensation after TIPS on the risk of hepatocellular carcinoma (HCC) and death, and we compared it with compensated cirrhosis patients.

Methods

An observational study of consecutive patients with cirrhosis undergoing TIPS between 2008 and 2022 was performed. Baveno VII definition of recompensation was used including patients with or without diuretics/Hepatic encephalopathy prophylaxis. A prospective cohort of consecutive compensated cirrhosis patients was used for comparison.

Results

Overall, 208 patients with cirrhosis were included, 92 compensated and 116 decompensated who underwent TIPS. After 1 year, 24% achieved recompensation. Liver function (MELD 12 ± 5 vs. 15 ± 6; p = .049), LDL-cholesterol (97 mg/dL vs. 76 mg/dL, p = .018), white cell count (7.96 × 10⁹/dL vs. 6.24 × 10⁹/dL, p = .039) and platelets (129 × 10⁹/dL vs. 101 × 10⁹/dL, p = .039) were associated with recompensation. Recompensation was associated with a reduction in the risk of HCC (p = .020). Multivariable analysis showed that this risk was significantly higher in non-recompensated patients (p = .003) but no differences were observed in recompensated compared with compensated patients (p = .816). Similarly, decompensated patients presented lower survival rates (p = .011), while no differences were observed between recompensated and compensated patients (p = .677).

Conclusions

Recompensation after TIPS has a clear impact on the incidence of HCC and death, with a similar prognosis than patients with compensated cirrhosis. Liver function is associated with recompensation, suggesting the importance of considering early TIPS in patients with indication.

Abstract Image

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TIPS 术后恢复可降低肝细胞癌的发病率，提高肝硬化患者的存活率。

背景和目的：有研究表明，肝硬化患者的再代偿可以改善预后。然而，经颈静脉肝内门体分流术（TIPS）后的再代偿尚未得到研究。我们评估了经颈静脉肝内门体系统分流术后再代偿对肝细胞癌（HCC）和死亡风险的影响，并将其与代偿期肝硬化患者进行了比较：方法：对2008年至2022年间连续接受TIPS治疗的肝硬化患者进行观察研究。研究采用了 Baveno VII 关于代偿期的定义，包括使用或未使用利尿剂/肝性脑病预防药物的患者。结果：共有208例肝硬化患者接受了TIPS治疗，其中92例为代偿期，116例为失代偿期。1 年后，24% 的患者恢复了肝功能。肝功能（MELD 12 ± 5 vs. 15 ± 6; p = .049）、低密度脂蛋白胆固醇（97 mg/dL vs. 76 mg/dL，p = .018）、白细胞计数（7.96 × 109/dL vs. 6.24 × 109/dL，p = .039）和血小板（129 × 109/dL vs. 101 × 109/dL，p = .039）与恢复相关。再补偿与 HCC 风险的降低有关（p = .020）。多变量分析表明，非失代偿患者的风险明显更高（p = .003），但与失代偿患者相比，失代偿患者与失代偿患者之间没有差异（p = .816）。同样，失代偿患者的存活率较低（p = .011），而再代偿患者与代偿患者之间没有差异（p = .677）：结论：TIPS术后失代偿对HCC发病率和死亡率有明显影响，其预后与代偿期肝硬化患者相似。肝功能与再代偿相关，这表明在有适应症的患者中考虑早期 TIPS 的重要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Liver International 医学-胃肠肝病学

CiteScore

13.90

自引率

4.50%

发文量

348

审稿时长

2 months

期刊介绍： Liver International promotes all aspects of the science of hepatology from basic research to applied clinical studies. Providing an international forum for the publication of high-quality original research in hepatology, it is an essential resource for everyone working on normal and abnormal structure and function in the liver and its constituent cells, including clinicians and basic scientists involved in the multi-disciplinary field of hepatology. The journal welcomes articles from all fields of hepatology, which may be published as original articles, brief definitive reports, reviews, mini-reviews, images in hepatology and letters to the Editor.