Identification of optimal portal pressure decrease to control ascites while minimizing hepatic encephalopathy after TIPS: A multicenter study

IF 12.9 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY
Martin A. Kabelitz, Lukas Hartl, Golda Schaub, Anja Tiede, Hannah Rieland, Andrea Kornfehl, Peter Hübener, Mathias Jachs, Jan Hinrichs, Sarah L. Schütte, Christoph Riedel, Jim B. Mauz, Tammo L. Tergast, Bernhard C. Meyer, Peter Bannas, Julia Kappel, Heiner Wedemeyer, Johannes Kluwe, Felix Piecha, Thomas Reiberger, Lisa Sandmann, Benjamin Maasoumy
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引用次数: 0

Abstract

Background & Aims: Clinically-significant portal hypertension (CSPH) in liver cirrhosis patients can lead to refractory ascites. A transjugular-intrahepatic-portosystemic shunt (TIPS) treats CSPH but may cause overt hepatic encephalopathy (oHE). Our aim was to determine the optimal reduction of the portal pressure gradient (PPG) via TIPS to control ascites without raising oHE risk. Approach: This multicenter study screened 1509 patients from three European centers (Hannover, Vienna, Hamburg) undergoing TIPS-implantation between 2000-2023. Patients with TIPS-indications other than refractory ascites/hepatic hydrothorax, vascular-liver-disease, hepatocellular-carcinoma or insufficient PPG data were excluded. PPG was measured before and after TIPS insertion. Outcome data was assessed up to one year after TIPS-insertion. Analyses were conducted utilizing a modern machine leaning model, namely a competing-risk (CR) random survival forest (RSF), partial-dependence-plots (PDP) and CR-analyses with liver transplantation/death as competitors. The cohort was divided into a 60% derivation and 40% validation cohort. Results: Overall, 729 patients (median MELD: 13 (IQR 10-16), 66% male, 23% oHE before TIPS) were analyzed. The derivation cohort comprised 438 and validation cohort 291 patients. The optimal PPG reduction, determined by maximally selected Grays-statistic and PDP of the RSF, was 60-80%. In this range, patients showed significantly fewer hepatic decompensations due to ascites (HDA) (sHR: 0.7 [0.52-0.96]) with similar oHE incidences (sHR: 0.92 [0.67-1.27]). The PPG range was confirmed in the validation cohort (HDA: sHR: 0.66 [0.46-0.96]; oHE: sHR: 0.89 [0.61-1.32]). Conclusions: A targeted PPG reduction of 60-80% showed significantly reduced HDA without increased oHE risk. Therefore, PPG reduction within this range could be a valid reduction target.
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来源期刊
Hepatology
Hepatology 医学-胃肠肝病学
CiteScore
27.50
自引率
3.70%
发文量
609
审稿时长
1 months
期刊介绍: HEPATOLOGY is recognized as the leading publication in the field of liver disease. It features original, peer-reviewed articles covering various aspects of liver structure, function, and disease. The journal's distinguished Editorial Board carefully selects the best articles each month, focusing on topics including immunology, chronic hepatitis, viral hepatitis, cirrhosis, genetic and metabolic liver diseases, liver cancer, and drug metabolism.
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