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- Title
Relationship Between Pre-TIPS Liver Perfusion by the Portal Vein and the Incidence of Post-TIPS Chronic Hepatic Encephalopathy.
- Authors
Hassoun, Ziad; Deschênes, Marc; Lafortune, Michel; Dufresne, Michel Pierre; Perreault, Pierre; Lepanto, Luigi; Gianfelice, David; Bui, Bao; Pomier-Layrargues, Gilles
- 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 <em>vs</em> 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 (<em>p</em> = 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.
- Subjects
HEPATITIS; CIRRHOSIS of the liver; PORTAL hypertension; ALCOHOLISM; PORTAL vein diseases; THROMBOSIS
- Publication
American Journal of Gastroenterology (Springer Nature), 2001, Vol 96, Issue 4, p1205
- ISSN
0002-9270
- Publication type
Article
- DOI
10.1111/j.1572-0241.2001.03704.x