iLIVER最新文献

{"title":"General-motors diet: A quick fix for steatotic live liver donors","authors":"Anish Gupta,&nbsp;Abhideep Chaudhary,&nbsp;Gaurav Sood,&nbsp;Niteen Kumar,&nbsp;Imtiakum Jamir,&nbsp;Aditya Shriya,&nbsp;Vipin Pal Singh,&nbsp;Rekha Subramaniyam,&nbsp;Hitesh Soni,&nbsp;Milind Mandwar","doi":"10.1016/j.iliver.2023.08.002","DOIUrl":"https://doi.org/10.1016/j.iliver.2023.08.002","url":null,"abstract":"<div><h3>Background and aims</h3><p>GM (General-Motors) diet is a low-calorie 7-day diet plan using complex carbohydrates used for quick weight loss. Dietary optimisation is known to decrease steatosis and improve outcomes in liver donors. We evaluated the efficacy and feasibility of using GM diet in steatotic live liver donors (LLD).</p></div><div><h3>Methods</h3><p>LLDs who either had BMI &gt; 30 kg/m², Computerised tomography liver attenuation index (CT-LAI) &lt; 0 HU, Magnetic resonance (MR) fat-fraction of &gt;10% were started on GM diet for 1 week. Records of these LLDs and their recipients were retrieved retrospectively and analysed. Weight, liver function tests(LFT), MR fat-fraction, CT-LAI, hospital-stay and complications were analysed in LLDs while early graft dysfunction (EGD) and complications were assessed in recipients.</p></div><div><h3>Results</h3><p>A total of 51 LLDs with mean age of 34.6±9.5 years with baseline mean weight of 80.6±10.8 kg and BMI of 29.1±2.78 kg/m² were started on GM diet. After a week of following the GM diet, there was an average weight loss of 3.46±2.1 kg, a decrease in fat-fraction by 3.8%±2.7, and an improvement in CT-LAI by 6.7±3.7 HU. All patients could successfully undergo donor hepatectomy with an average postoperative ICU stay of 2.86±0.8 days and hospital stay of 6.82±0.81 days. No donor had steatosis &gt; 10% on intraoperative Tru-cut biopsy and their post-operative outcomes were similar to normal liver donors. There were intra-abdominal collections in 2 donors requiring drainage and one required re-exploration for intestinal obstruction. There was EGD in 8 recipients (15.6%) and mortality in 1(1.9%) recipients.</p></div><div><h3>Conclusion</h3><p>GM diet is safe and effective regimen to reduce steatosis and increase healthy LLD pool without compromising donor or recipient safety.</p></div>","PeriodicalId":100657,"journal":{"name":"iLIVER","volume":"2 3","pages":"Pages 151-155"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49735246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficiency and safety of sofosbuvir in Bangladeshi children with chronic hepatitis C virus infection","authors":"Salahuddin Mahmud ,&nbsp;Jahida Gulshan ,&nbsp;Md. Belayet Hossain ,&nbsp;Madhabi Baidya ,&nbsp;Rafia Rashid ,&nbsp;Farhana Tasneem ,&nbsp;Ahmed Rashidul Hasan ,&nbsp;Tanzila Farhana ,&nbsp;Mohammed Reaz Mobarak ,&nbsp;Md. Jahangir Alam ,&nbsp;Syed Shafi Ahmed","doi":"10.1016/j.iliver.2023.06.002","DOIUrl":"https://doi.org/10.1016/j.iliver.2023.06.002","url":null,"abstract":"<div><h3>Background and aims</h3><p>Currently, treatment with oral direct-acting antivirals is recommended for all hepatitis C virus (HCV)-infected pediatric patients. The aim of this study was to evaluate the efficacy and safety of sofosbuvir and ribavirin combination therapy for children and adolescents in Bangladesh who are living with chronic HCV infection.</p></div><div><h3>Methods</h3><p>An experimental study was performed from January 2021 to December 2022. HCV polymerase chain reaction (PCR)-positive thalassemic children, who were 6–18 years of age, were enrolled by consecutive nonprobability sampling. Clinical features were recorded, and investigations were performed. All patients were initially treated with sofosbuvir (200 mg for 6- to 11-year-olds and 400 mg for 12- to 18-year-olds) and ribavirin (10–15 mg/kg/day) and were assessed clinically on a four-weekly basis, along with liver-function testing. The total duration of therapy was 24 weeks. HCV PCR was done at the end of treatment and 12 weeks after the completion of treatment to see the sustained virological response.</p></div><div><h3>Results</h3><p>There were 26 cases in total, with a mean age of 9.26 ± 2.82 years; 14 were males (53.8%), and 12 females (46.2%). Twenty-five (96.15%) patients achieved a sustained virological response, and the end-of-treatment PCR was negative. One patient (3.85%) was a nonresponder even after 24 weeks of treatment. The medication was well received, with only four patients (15.3%) reporting headaches that were reported untreated.</p></div><div><h3>Conclusion</h3><p>The combination of sofosbuvir and ribavirin is effective in treating chronic HCV infection and is not accompanied by any major negative side effects.</p></div>","PeriodicalId":100657,"journal":{"name":"iLIVER","volume":"2 3","pages":"Pages 146-150"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49717062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The evolution of available pharmacological treatments for variceal bleeding secondary to portal hypertension: A scope review","authors":"Eduarda Raísa Coser ,&nbsp;Raphael Bernardo Neto ,&nbsp;Izabel Cristina Meister Martins Coelho ,&nbsp;Norma Possa Marroni ,&nbsp;Claudio Augusto Marroni ,&nbsp;Camila Moraes Marques","doi":"10.1016/j.iliver.2023.08.005","DOIUrl":"https://doi.org/10.1016/j.iliver.2023.08.005","url":null,"abstract":"<div><p>Variceal bleeding is one of the main complications of portal hypertension and it presents with 30 to 50% mortality in hospitalized patients. During the period between 1990 to 2017, more than 1.32 million deaths in the world were related to cirrhosis what makes necessary to map available treatments to variceal bleeding secondary to portal hypertension and to analyze the results of the described treatments. The method selected to this study is a scoping review based on the methodology proposed by the Joanna Briggs Institute (JBI) and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews Checklist (PRISMA-SCr) guidelines. The guiding question was defined as: \"What treatments are available for variceal bleeding secondary to portal hypertension?\". Based on these, 2870 articles were identified in the databases, 2446 were screened and 562 were selected for analysis by title and abstract. The texts analyzed in full totaled 110, of which 36 articles published between 2001 and 2020 were selected, with quantitative approaches, case reviews, literature reviews, meta-analyses, and guidelines. It is concluded that beta-blockers are the drugs of choice for primary prophylaxis of variceal bleeding. As for secondary prophylaxis, there is an association of these with nitrates and endoscopic ligation. With regard to acute bleeding, the use of vasoactive drugs is chosen, especially terlipressin. Finally, it is important to emphasize that there is a shortage of clinical studies and a need for investment in new therapies.</p></div>","PeriodicalId":100657,"journal":{"name":"iLIVER","volume":"2 3","pages":"Pages 170-176"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49717252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"More precise measurement of irregular splenic volume in cirrhotic patients with portal hypertension","authors":"Xiao Chen ,&nbsp;Tao Yang ,&nbsp;Dong Wang ,&nbsp;Bo Huang ,&nbsp;Yanlong Cao ,&nbsp;Jianguo Lu ,&nbsp;Lei Cai ,&nbsp;Jikai Yin","doi":"10.1016/j.iliver.2023.04.002","DOIUrl":"https://doi.org/10.1016/j.iliver.2023.04.002","url":null,"abstract":"<div><h3>Background and aims</h3><p>Splenomegaly often occurs in cirrhotic patients with portal hypertension (PHT), and therefore, the efficacy and accuracy of conventional methods for measuring splenic volume are a matter of question in these patients. Here, we developed a novel approach to assess true splenic volume more precisely.</p></div><div><h3>Methods</h3><p>High-quality thin-slice computed tomography data of 112 cirrhotic patients with PHT were obtained and reviewed. Both the conventional measurement and a novel formula obtained from 3-dimensional reconstruction software were used to estimate splenic volume, and the accuracy was compared and verified.</p></div><div><h3>Results</h3><p>In PHT patients, the splenic volume calculated using the conventional method was significantly less than that calculated using the 3-dimensional software. We found that the splenic volume was significantly positively correlated with splenic indices of length (L), thickness (T), and width (W) and also the diameter of the splenic vein. Using these indices, we propose 2 novel formulas using the software to estimate the splenic volume more accurately: SV = 69.686 × L + 53.077 × W + 103.525 × T + 314.510 × diameter of splenic vein −2266.209 (<em>p</em> &lt; 0.01, <em>R</em>^<em>2</em> = 0.805). And a more practical simplified formula: SV' = 0.504 × L × W × Τ + 319.762 × diameter of splenic vein −81.66 (<em>p</em> &lt; 0.01, <em>R</em>^<em>2</em> = 0.784).</p></div><div><h3>Conclusion</h3><p>Although the conventional formula has been widely used for years, it is not suitable for an enlarged spleen. We developed 2 novel formulas for estimating splenic volume from clinical data that were more appropriate for cirrhotic patients with PHT.</p></div>","PeriodicalId":100657,"journal":{"name":"iLIVER","volume":"2 2","pages":"Pages 109-115"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49735115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systematic review and meta-analysis: Comparing hepatocellular and cholestatic patterns of drug-induced liver injury","authors":"Georgia Zeng ,&nbsp;Guy D. Eslick ,&nbsp;Martin Weltman","doi":"10.1016/j.iliver.2023.05.002","DOIUrl":"https://doi.org/10.1016/j.iliver.2023.05.002","url":null,"abstract":"<div><h3>Background and aims</h3><p>Drug-induced liver injury (DILI) is a leading cause of death from acute liver failure (ALF). Hy's law warns that a hepatocellular pattern of injury accompanied by jaundice and normal alkaline phosphatase (ALP) levels is associated with a 10% or greater chance of progression to transplant or liver-related death. This meta-analysis of DILI studies evaluates acute and chronic outcomes of DILI according to clinical pattern of injury.</p></div><div><h3>Methods</h3><p>We conducted a systematic search using electronic databases PubMed and EMBASE through to 8 March 2022. Our primary outcome was to compare acute outcomes including ALF, liver-related death, and liver transplant between patients experiencing hepatocellular, cholestatic, and mixed patterns of DILI. Our secondary outcome was to compare the rate of DILI chronicity between patients of these three differing patterns of injury. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using a random-effects model.</p></div><div><h3>Results</h3><p>Overall, 12 studies comprising 4290 patients were included. Patients with cholestatic DILI demonstrated similar rates of ALF (OR: 0.80, 95% CI: 0.46–1.40, <em>p</em> = 0.429) and liver-related death (OR: 0.92, 95% CI: 0.50–1.69, <em>p</em> = 0.792) compared to patients with hepatocellular DILI. Patients with cholestatic DILI were significantly more likely to experience chronicity compared to patients with hepatocellular DILI (OR: 2.53, 95% CI: 1.34–4.79, <em>p</em> = 0.004).</p></div><div><h3>Conclusion</h3><p>Hy's law conceives severe DILI as an exclusive consequence of hepatocellular pattern of injury. Our results demonstrate that cholestatic injury can be associated with similarly poor rates of ALF and liver-related fatality, as well as higher rates of chronic DILI.</p></div>","PeriodicalId":100657,"journal":{"name":"iLIVER","volume":"2 2","pages":"Pages 122-129"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49717275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hepatic allograft rejection after liver transplantation: Clinicopathological debates!","authors":"Nourhan Badwei","doi":"10.1016/j.iliver.2023.05.003","DOIUrl":"https://doi.org/10.1016/j.iliver.2023.05.003","url":null,"abstract":"<div><p>Liver transplantation (LT) represents a life-saving surgical procedure and is considered the current standard of care for the majority of patients having end-stage liver disease. As known, significant progress in organ preservation techniques, perioperative care, and strict immunosuppression protocols are associated with favorable patient/graft survival post-LT. Hence, proper evaluation of liver allograft-related complications among survivors has paid great attention, particularly the rejection sequel after LT. It is a seriously underestimated cause of allograft injury, which pushes researchers for understanding the exact pathogenesis of different types and proper time diagnosis for better management of such complications. However, it still represents a challenge because of the complexities related to diagnosis and histopathology. Hence, increasing clinical awareness with earlier diagnosis of post-LT rejection is essential through stimulating further studies. Therefore, our review will focus on the clinicopathological debates regarding liver allograft loss after transplantation.</p></div>","PeriodicalId":100657,"journal":{"name":"iLIVER","volume":"2 2","pages":"Pages 116-121"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49735359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The analysis of the adherence of liver transplant recipients to immunosuppressant treatment, their self-control, and self-management in the post-transplantation period","authors":"Fadime Çınar ,&nbsp;Semra Bulbuloglu","doi":"10.1016/j.iliver.2023.05.001","DOIUrl":"https://doi.org/10.1016/j.iliver.2023.05.001","url":null,"abstract":"<div><h3>Background and amis</h3><p>In our study, it was aimed to investigate the adherence of liver transplant recipients to immunosuppressant therapy, their self-control, and their self-management in the post-transplantation period.</p></div><div><h3>Methods</h3><p>The sample of this descriptive and cross-sectional study was composed of liver transplant recipients. The personal information form, Immunosuppressant Therapy Adherence Scale, and the Liver Self-Control and Self-Management Scale were used to collect data, and descriptive statistical methods, independent samples t-test and one-way analysis of variance analysis was used to analyze the collected data.</p></div><div><h3>Results</h3><p>In light of the data collected in this study, it was identified that, of all recipients, 73.6% were 45–64 years old, 72.5% were male, 25.2% were workers, and 44.6% had equivalent income and expenses. It was observed that the recipients did not fully adhere to the immunosuppressant therapy regimen, and their self-control and self-management levels were below the medium level.</p></div><div><h3>Conclusion</h3><p>The social support system of liver transplant recipients is very important. Recipients with a good social support system can receive caregiver support from their relatives, thereby supporting their self-control and self-management. Both liver transplant patients and the people providing care to them should be simultaneously provided with training programs and given information, and both groups should be supported in treatment and care processes.</p></div>","PeriodicalId":100657,"journal":{"name":"iLIVER","volume":"2 2","pages":"Pages 97-102"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49735245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Altered expression in liver cancer with various hepatic blood flow occlusions: A pilot RNA sequencing study","authors":"Xuning Wang ,&nbsp;Lili Zhang ,&nbsp;Maolin Xu ,&nbsp;Bin Shi","doi":"10.1016/j.iliver.2023.04.001","DOIUrl":"https://doi.org/10.1016/j.iliver.2023.04.001","url":null,"abstract":"<div><h3>Background and aims</h3><p>Hepatocellular carcinoma is one of the most common cancers worldwide. Previous studies have reported he influence of various hepatic blood flow occlusions on tumor behavior, which is mainly mediated by liver ischemia-reperfusion. Although some genes and pathways have been determined, the whole transcriptome after various hepatic blood flow occlusions is lacking.</p></div><div><h3>Methods</h3><p>We systematically explored transcriptome changes after various hepatic blood flow occlusions, including sham operation (SO; <em>n</em> = 10), occlusion of the portal triad (OPT; <em>n</em> = 10), and occlusion of the portal vein (OPV; <em>n</em> = 10), by RNA-sequencing.</p></div><div><h3>Results</h3><p>HE sections and TUNEL assays showed different liver injury among groups. We identified the top altered genes and pathways. Compared with the SO group, 96 genes were altered in OPV, with 81 upregulated and 15 downregulated genes. The top 5 upregulated genes were <em>Pdk4</em>, <em>Serpina12</em>, <em>Depp1</em>, <em>Igfbp1</em>, and <em>Mup22</em>. The top 5 downregulated genes were <em>Sprr1a</em>, <em>Serpinb2</em>, <em>Tnc</em>, <em>Cdkn3</em>, and <em>Cenpu</em>. Compared with the SO group, there were 20 differentially expressed genes in OPT, with 18 upregulated and 2 downregulated genes. The top 5 upregulated genes were <em>C7</em>, <em>Zbtb16</em>, <em>Gabrp</em>, <em>Pdk4</em>, and <em>Mmrn1</em>. The top 2 downregulated genes were <em>Krt20</em> and <em>Sis</em>. Compared with the OPV group, 72 differentially expressed genes were in OPT, with 39 upregulated and 33 downregulated genes. The top 5 upregulated genes were <em>Hspa1b</em>, <em>Hbb-bs</em>, <em>Phf19</em>, <em>Ddias</em>, and <em>Rad54b</em>. The top 5 downregulated genes were <em>Cish</em>, <em>Socs2</em>, <em>Slc25a30</em>, <em>Rgs3</em>, and <em>Hsd3b5</em>.</p></div><div><h3>Conclusion</h3><p>Various surgical methods have an obvious influence on the transcriptome of tumors.</p></div>","PeriodicalId":100657,"journal":{"name":"iLIVER","volume":"2 2","pages":"Pages 103-108"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49717060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and complications of transarterial chemoembolization alone or in combination with different protocols for hepatocellular carcinoma: A Bayesian network meta-analysis of randomized controlled trials","authors":"Jingxin Yan ,&nbsp;Manjun Deng ,&nbsp;Ting Li ,&nbsp;Changhao Dong ,&nbsp;Minglan Wang ,&nbsp;Shunyu Kong ,&nbsp;Yingxing Guo ,&nbsp;Haining Fan","doi":"10.1016/j.iliver.2023.03.002","DOIUrl":"https://doi.org/10.1016/j.iliver.2023.03.002","url":null,"abstract":"<div><h3>Background and aims</h3><p>Transarterial chemoembolization (TACE) is the standard treatment for most intermediate-to-advanced stage hepatocellular carcinoma. With the ongoing development of interventional therapies, TACE in combination with different protocols is being explored. A network meta-analysis to collect recent evidence in this field is required.</p></div><div><h3>Methods</h3><p>We searched PubMed, Web of Science, Cochrane Central Register of Controlled Trials, Embase, Chinese National Knowledge Infrastructure database, Cochrane Library, and Wanfang database from their inception to May 2022 for randomized controlled trials (RCTs) that reported TACE in combination with different protocols for hepatocellular carcinoma.</p></div><div><h3>Results</h3><p>In total, 67 RCTs assessing eight combination treatments were included. The quality of primary outcomes was from moderate to low. The Bayesian network meta-analysis confirmed that TACE combined with iodine-125 seed implantation had the highest probability of 1-year survival rate and TACE combined with sorafenib had the highest probability of 2-year survival rate. TACE alone had the highest probability of incidence of fever, TACE combined with sorafenib had the highest probability of incidence of pain and TACE combined with percutaneous ethanol injection had the highest probability of incidence of nausea and vomiting.</p></div><div><h3>Conclusion</h3><p>This Bayesian network meta-analysis found that TACE combined with iodine-125 seed and TACE combined with sorafenib may benefit patients in terms of 1-year survival and 2-year survival, respectively. To confirm this conclusion, high-quality and well-designed RCTs with a larger sample size are needed.</p></div>","PeriodicalId":100657,"journal":{"name":"iLIVER","volume":"2 2","pages":"Pages 130-141"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49717250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The transjugular intrahepatic portosystemic shunt: Smaller stent diameters are required to optimize pressure response","authors":"Martin Rössle ,&nbsp;Dominik Bettinger ,&nbsp;Robert Thimme ,&nbsp;Michael Schultheiss","doi":"10.1016/j.iliver.2023.05.004","DOIUrl":"https://doi.org/10.1016/j.iliver.2023.05.004","url":null,"abstract":"<div><h3>Background and aims</h3><p>The present treatment goal of the transjugular intrahepatic portosystemic shunt (TIPS) is a portosystemic pressure gradient of ≤12 mmHg or its reduction by &gt;50%. This study relates the stent diameter to the reduction of the pressure gradient and attempts to predict the appropriate stent diameter necessary to reach the treatment goal.</p></div><div><h3>Methods</h3><p>Pressure response, super response, and poor response were investigated in 208 de-novo TIPS patients and defined as post-TIPS gradients between &gt;6 and 12 mmHg, ≤6 mmHg, or not reaching the goal (&gt;12 mmHg, reduction &lt;50%), respectively. Pressures were related to the smallest stent diameters measured by planimetry of the radiographic image.</p></div><div><h3>Results</h3><p>Responders (65%), super responders (26%), or poor responders (9%) had comparable stent diameters of 7.2 ± 1.0 mm, but different post-TIPS gradients (9.7 ± 1.9 mmHg, 4.5 ± 1.5 mmHg, and 14.2 ± 1.4 mmHg, <em>p</em> &lt; 0.001), relative reduction of pre-TIPS gradients (51.7 ± 11.4%, 73.6 ± 11.1%, and 34.0 ± 9.1%, <em>p</em> &lt; 0.001), and specific reduction per mm of stent diameter (7.5 ± 2.0%/mm, 10.1 ± 2.0%/mm, and 4.8 ± 1.4%/mm, <em>p</em> &lt; 0.001). Prediction of the stent diameter required to reach response was not possible. Only two super responders had a stent diameter of &lt;6 mm. Super and poor responders differed by the increase in the right atrial pressure (+5.0 mmHg vs. +3.1 mmHg, <em>p</em> = 0.026) and reduction in the portal vein pressure (−8.6 mmHg vs. −4.6 mmHg, <em>p</em> &lt; 0.001).</p></div><div><h3>Conclusion</h3><p>Most patients reached the treatment goal with stent diameters of &lt;8 mm. Overtreatment (super response, gradient ≤6 mmHg) can be prevented by stent diameters as small as 6 mm. The individual response was not related to the stent diameter and not predictable. Cardiac dysfunction may play an important role by its effect on the right atrial (preload) and portal pressure (afterload).</p></div>","PeriodicalId":100657,"journal":{"name":"iLIVER","volume":"2 2","pages":"Pages 89-96"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49717342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}