Recurrent Portal Hypertension after Liver Transplant: Impact on Survival and the Role of TIPS Creation in Management.

IF 2.6 3区医学 Q2 PERIPHERAL VASCULAR DISEASE

Journal of Vascular and Interventional Radiology Pub Date : 2025-01-21 DOI:10.1016/j.jvir.2025.01.027

Fayez Jabboure, Michael Darcy, Steven Sauk, Zachary Abrams, Kevin Korenblat, Seung Kim, Nassir Rostambeigi

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引用次数: 0

Abstract

Introduction: Recurrent portal hypertension (PH) after liver transplant (LT) and its management are not well-studied. This study aims to evaluate the impact of transjugular intrahepatic portosystemic shunt (TIPS) on outcomes of recurrent PH.

Methods: From a cohort of 1846 LT recipients, 36 patients who underwent TIPS creation after LT were identified and considered as cases. To streamline comparison with the remaining LT patients without TIPS, a representative subset comprising more than 20% of the entire population (381/1810) was randomly selected. Diuretic refractory ascites, and endoscopic findings were reviewed to detect recurrent PH in patients without TIPS. Repeat transplantation, and graft and overall survival were compared between recurrent PH patients with and without TIPS. Survival analysis with multivariable Cox regression analysis was used for risk factors of survival.

Results: Out of 1846 patients, 36 (2%) underwent TIPS after LT. Among the control group, 24 (of 381, 6.3%) patients had recurrent PH. TIPS resulted in ascites resolution in 25 (of 36, 74%). Repeat transplant was more frequent in recurrent PH without TIPS, than recurrent PH with TIPS (33% vs. 11%, p=0.035). Median overall survival after TIPS was 2.4 years (95% CI: 0.6-3.2). Transplant-free survival after initial LT was not different between patients with or without TIPS (8.6 years vs. 7.6 years, p=0.360). Multivariable Cox regression showed that repeat transplant was associated with reduced mortality in recurrent PH (HR=0.15, p=0.016).

Conclusion: Recurrent PH after LT is rare, but adversely impacts patient outcomes. However, TIPS in recurrent PH improves ascites without worsening survival.

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来源期刊

Journal of Vascular and Interventional Radiology 医学-核医学

CiteScore

4.30

自引率

10.30%

发文量

942

审稿时长

90 days

期刊介绍： JVIR, published continuously since 1990, is an international, monthly peer-reviewed interventional radiology journal. As the official journal of the Society of Interventional Radiology, JVIR is the peer-reviewed journal of choice for interventional radiologists, radiologists, cardiologists, vascular surgeons, neurosurgeons, and other clinicians who seek current and reliable information on every aspect of vascular and interventional radiology. Each issue of JVIR covers critical and cutting-edge medical minimally invasive, clinical, basic research, radiological, pathological, and socioeconomic issues of importance to the field.