Portal Fibrotic Cord is Associated with Transjugular Intrahepatic Portosystemic Shunt Failure and Death in Cirrhotic Patients

Yunshu Yang; Chuangye He; Xulong Yuan; Kai Li; Wenyuan Jia; Jing Niu; Na Han; Jiao Xu; Ying Zhu; Li Xu; Yuxuan Mao; Yuanping Xu; Xiaoyuan Gou; Jun Tie

doi:10.14218/JCTH.2022.00391

Portal Fibrotic Cord is Associated with Transjugular Intrahepatic Portosystemic Shunt Failure and Death in Cirrhotic Patients

J Clin Transl Hepatol. 2023 Aug 28;11(4):809-816. doi: 10.14218/JCTH.2022.00391. Epub 2023 Jan 4.

Authors

Yunshu Yang¹, Chuangye He¹, Xulong Yuan¹, Kai Li¹, Wenyuan Jia¹, Jing Niu¹, Na Han¹, Jiao Xu¹, Ying Zhu¹, Li Xu¹, Yuxuan Mao¹, Yuanping Xu¹, Xiaoyuan Gou¹, Jun Tie¹

Affiliation

¹ National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Air Force Medical University, Xi'an, Shaanxi, China.

Abstract

Background and aims: Occlusive portal vein thrombosis (PVT) often causes portal hypertension-related complications in cirrhotic patients. Transjugular intrahepatic portosystemic shunt (TIPS) is an effective treatment for this difficult problem. However, the factors influencing TIPS success and overall survival in patients with occlusive PVT are unknown. This study investigated the factors influencing TIPS success and overall survival in cirrhotic patients with occlusive PVT.

Methods: Cirrhotic patients with occlusive PVT were selected from a prospective database of consecutive patients treated with TIPS in Xijing Hospital between January 2015 and May 2021. Baseline characteristics, TIPS success rate, complications, and survival were collected, and the factors associated with the TIPS success rate and transplant-free survival were analyzed.

Results: A total of 155 cirrhotic patients with occlusive PVT were enrolled. TIPS succeeded in 126 (81.29%) cases. The 1-year survival rate was 74%. Compared with those without, patients with portal fibrotic cord had a lower TIPS success rate (39.02% vs. 96.49%, p<0.001), shorter median overall survival (300 vs. 1,730 days, p<0.001) and more operation-related complications (12.20% vs. 1.75%, p<0.01). Logistic regression analysis found that portal fibrotic cord (odds ratio 0.024) was a risk factor for TIPS failure. Univariate and multivariate analysis showed that portal fibrotic cord was an independent predictor of death (hazard ratio 2.111; 95% CI: 1.094-4.071, p=0.026).

Conclusions: Portal fibrotic cord increased the TIPS failure rate and is a risk factor for poor prognosis in cirrhotic patients.

Keywords: Fibrotic cord; Liver cirrhosis; Occlusive portal vein thrombosis; Portal hypertension-related complications; Transjugular intrahepatic portosystemic shunt.