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Transjugular intrahepatic portosystemic shunt creation for cirrhotic portal hypertension is well tolerated among patients with portal vein thrombosis

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Background

Portal vein thrombosis (PVT) develops in cirrhotic patients because of stagnation of blood flow. Transjugular intrahepatic portosystemic shunt (TIPS) creates a low-resistance conduit that restores portal venous patency and blood flow.

Aim

The effect of PVT on transplant-free survival in cirrhotic patients undergoing TIPS creation was evaluated.

Patients and methods

A multicenter, retrospective cohort study of patients who underwent TIPS creation for cirrhotic portal hypertension was carried out. A Cox model with propensity score adjustment was developed to evaluate the effect of PVT on 90-day and 3-year transplant-free survival. A subgroup analysis examining mortality of those with superior and inferior PVT was also carried out.

Results

A total of 252 consecutive TIPS creations were assessed, including 65 in patients with PVT. Survival of patients with high Model for End-stage Liver Disease scores (≥18) and PVT was not statistically different compared with patients with low Model for End-stage Liver Disease scores (<18) and no PVT at 90 days (P=0.46) and 3 years (P=0.42). Those with superior PVT had improved 90-day and 3-year survival both compared with patients with a inferior PVT and those without a PVT (P<0.01, all cases).

Conclusion

The presence of PVT does not impair the prognosis of patients following TIPS creation, particularly in patients with superior portal occlusion.
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Keywords: cirrhosis; coagulopathy; mortality; variceal bleeding

Document Type: Research Article

Affiliations: 1: Departments of Surgery 2: Division of Gastroenterology and Hepatology, Weil-Cornell Medical Center 3: Yale School of Public Health, Yale Center for Analytical Sciences, New Haven, Connecticut 4: Albany Hospital Medical Imaging, Albany 5: Departments of Medicine 6: Radiology, New York University School of Medicine 7: Radiology, Yale School of Medicine 8: Northwell Health, Manhasset 9: Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA

Publication date: June 1, 2018

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