Reduced risk of overt hepatic encephalopathy and death after transjugular intrahepatic portosystemic shunt in patients with hepatic venovenous communications
[Display omitted] •Hepatic venovenous communications (HVVC) affect the assessment of portal hypertension.•Presence of HVVC implies better-preserved effective intrahepatic perfusion.•HVVC indicates a favorable prognosis after transjugular intrahepatic portosystemic shunt. Hepatic venovenous communica...
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| Veröffentlicht in: | European journal of radiology 2024-08, Vol.177, p.111554, Article 111554 |
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| container_title | European journal of radiology |
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| creator | Ma, Li Ma, Jingqin Zhang, Wen Yu, Jiaze Zhang, Zihan Yang, Minjie Zhou, Yongjie Ju, Shuai Gu, Guoqiang Luo, Jianjun Yan, Zhiping |
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•Hepatic venovenous communications (HVVC) affect the assessment of portal hypertension.•Presence of HVVC implies better-preserved effective intrahepatic perfusion.•HVVC indicates a favorable prognosis after transjugular intrahepatic portosystemic shunt.
Hepatic venovenous communications (HVVC) is detectable in more than one-third of cirrhotic patients, where portal hypertension (PHT) tends to present more severely. We aimed to explore the prognostic implications of HVVC in patients with sinusoidal PHT treated by transjugular intrahepatic portosystemic shunt (TIPS).
The multicenter data of patients (2020–2022) undergoing balloon-occluded hepatic venography during TIPS were retrospectively analyzed. Pre-TIPS total bile acids (TBA) levels in portal, hepatic and peripheral veins were compared between groups. The primary endpoint was the development of overt hepatic encephalopathy (HE) within one year after TIPS.
183 patients were eligible and classified by the presence (n = 69, 37.7 %) or absence (n = 114, 62.3 %) of HVVC. The agreement between wedged hepatic venous pressure and portal venous pressure was poor in HVVC group (intraclass correlation coefficients [ICC]: 0.141, difference: 13.4 mmHg, p |
| doi_str_mv | 10.1016/j.ejrad.2024.111554 |
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•Hepatic venovenous communications (HVVC) affect the assessment of portal hypertension.•Presence of HVVC implies better-preserved effective intrahepatic perfusion.•HVVC indicates a favorable prognosis after transjugular intrahepatic portosystemic shunt.
Hepatic venovenous communications (HVVC) is detectable in more than one-third of cirrhotic patients, where portal hypertension (PHT) tends to present more severely. We aimed to explore the prognostic implications of HVVC in patients with sinusoidal PHT treated by transjugular intrahepatic portosystemic shunt (TIPS).
The multicenter data of patients (2020–2022) undergoing balloon-occluded hepatic venography during TIPS were retrospectively analyzed. Pre-TIPS total bile acids (TBA) levels in portal, hepatic and peripheral veins were compared between groups. The primary endpoint was the development of overt hepatic encephalopathy (HE) within one year after TIPS.
183 patients were eligible and classified by the presence (n = 69, 37.7 %) or absence (n = 114, 62.3 %) of HVVC. The agreement between wedged hepatic venous pressure and portal venous pressure was poor in HVVC group (intraclass correlation coefficients [ICC]: 0.141, difference: 13.4 mmHg, p < 0.001), but almost perfect in non-HVVC group (ICC: 0.877, difference: 0.4 mmHg, p = 0.152). At baseline, patients with HVVC had lower Model for end-stage liver disease scores (p < 0.001), blood ammonia levels (p < 0.001), TBA concentrations in the hepatic (p = 0.011) and peripheral veins (p = 0.049) rather than in the portal veins (p = 0.516), and a higher portosystemic pressure gradient (p = 0.035), suggesting more effective intrahepatic perfusion in this group. Within 1-year post-TIPS, HVVC group had a lower incidence of overt HE (11.7 % vs. 30.5 %, p = 0.004, HR: 0.34, 95 % CI: 0.16–0.74, absolute risk difference [ARD]: −17.4) and an improved liver transplantation-free survival rate (97.1 % vs. 86.8 %, p = 0.021, HR: 0.16, 95 % CI: 0.05–0.91, ARD: −10.3).
For patients with sinusoidal PHT treated by TIPS, the presence of HVVC was associated with a reduced risk of overt HE and a potential survival benefit.</description><identifier>ISSN: 0720-048X</identifier><identifier>ISSN: 1872-7727</identifier><identifier>EISSN: 1872-7727</identifier><identifier>DOI: 10.1016/j.ejrad.2024.111554</identifier><identifier>PMID: 38850724</identifier><language>eng</language><publisher>Ireland: Elsevier B.V</publisher><subject>Bile acids ; Decompensated cirrhosis ; Intrahepatic shunting ; Intrahepatic vascular remodeling ; Portal hypertension</subject><ispartof>European journal of radiology, 2024-08, Vol.177, p.111554, Article 111554</ispartof><rights>2024</rights><rights>Copyright © 2024. Published by Elsevier B.V.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c309t-48116ee74ba2083854b5ad529a8260297d8e5d22f68e5caf4c7b6bb7522ad5c53</cites><orcidid>0000-0003-4942-0439</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0720048X24002705$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38850724$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ma, Li</creatorcontrib><creatorcontrib>Ma, Jingqin</creatorcontrib><creatorcontrib>Zhang, Wen</creatorcontrib><creatorcontrib>Yu, Jiaze</creatorcontrib><creatorcontrib>Zhang, Zihan</creatorcontrib><creatorcontrib>Yang, Minjie</creatorcontrib><creatorcontrib>Zhou, Yongjie</creatorcontrib><creatorcontrib>Ju, Shuai</creatorcontrib><creatorcontrib>Gu, Guoqiang</creatorcontrib><creatorcontrib>Luo, Jianjun</creatorcontrib><creatorcontrib>Yan, Zhiping</creatorcontrib><title>Reduced risk of overt hepatic encephalopathy and death after transjugular intrahepatic portosystemic shunt in patients with hepatic venovenous communications</title><title>European journal of radiology</title><addtitle>Eur J Radiol</addtitle><description>[Display omitted]
•Hepatic venovenous communications (HVVC) affect the assessment of portal hypertension.•Presence of HVVC implies better-preserved effective intrahepatic perfusion.•HVVC indicates a favorable prognosis after transjugular intrahepatic portosystemic shunt.
Hepatic venovenous communications (HVVC) is detectable in more than one-third of cirrhotic patients, where portal hypertension (PHT) tends to present more severely. We aimed to explore the prognostic implications of HVVC in patients with sinusoidal PHT treated by transjugular intrahepatic portosystemic shunt (TIPS).
The multicenter data of patients (2020–2022) undergoing balloon-occluded hepatic venography during TIPS were retrospectively analyzed. Pre-TIPS total bile acids (TBA) levels in portal, hepatic and peripheral veins were compared between groups. The primary endpoint was the development of overt hepatic encephalopathy (HE) within one year after TIPS.
183 patients were eligible and classified by the presence (n = 69, 37.7 %) or absence (n = 114, 62.3 %) of HVVC. The agreement between wedged hepatic venous pressure and portal venous pressure was poor in HVVC group (intraclass correlation coefficients [ICC]: 0.141, difference: 13.4 mmHg, p < 0.001), but almost perfect in non-HVVC group (ICC: 0.877, difference: 0.4 mmHg, p = 0.152). At baseline, patients with HVVC had lower Model for end-stage liver disease scores (p < 0.001), blood ammonia levels (p < 0.001), TBA concentrations in the hepatic (p = 0.011) and peripheral veins (p = 0.049) rather than in the portal veins (p = 0.516), and a higher portosystemic pressure gradient (p = 0.035), suggesting more effective intrahepatic perfusion in this group. Within 1-year post-TIPS, HVVC group had a lower incidence of overt HE (11.7 % vs. 30.5 %, p = 0.004, HR: 0.34, 95 % CI: 0.16–0.74, absolute risk difference [ARD]: −17.4) and an improved liver transplantation-free survival rate (97.1 % vs. 86.8 %, p = 0.021, HR: 0.16, 95 % CI: 0.05–0.91, ARD: −10.3).
For patients with sinusoidal PHT treated by TIPS, the presence of HVVC was associated with a reduced risk of overt HE and a potential survival benefit.</description><subject>Bile acids</subject><subject>Decompensated cirrhosis</subject><subject>Intrahepatic shunting</subject><subject>Intrahepatic vascular remodeling</subject><subject>Portal hypertension</subject><issn>0720-048X</issn><issn>1872-7727</issn><issn>1872-7727</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><recordid>eNp9kc-OFCEQxonRuOPqE5gYjl56FuimoQ8ezMY_m2xiYjTxRmiodmi7oQV6zDyM7yrt7Hj0QIqifl8V8CH0kpI9JbS9GfcwRm33jLBmTynlvHmEdlQKVgnBxGO0I4KRijTy2xV6ltJICOFNx56iq1pKXorNDv3-DHY1YHF06QcOAw5HiBkfYNHZGQzewHLQUyjp4YS1t9hC2WI9ZIg4R-3TuH5fJx2x8yW9CJcQc0inlGEuWTqsPhcAb0XwOeFfrjS5wEfwYVtrwibM8-qdKefBp-foyaCnBC8e4jX6-v7dl9uP1f2nD3e3b-8rU5MuV42ktAUQTa8ZkbXkTc-15azTkrWEdcJK4JaxoS3R6KExom_7XnDGCmZ4fY1en_suMfxcIWU1u2RgmrSHcitVk5Z3suWkLmh9Rk0MKUUY1BLdrONJUaI2X9So_vqiNl_U2ZeievUwYO1nsP80FyMK8OYMQHnm0UFUybjt962LYLKywf13wB8DHKSa</recordid><startdate>20240801</startdate><enddate>20240801</enddate><creator>Ma, Li</creator><creator>Ma, Jingqin</creator><creator>Zhang, Wen</creator><creator>Yu, Jiaze</creator><creator>Zhang, Zihan</creator><creator>Yang, Minjie</creator><creator>Zhou, Yongjie</creator><creator>Ju, Shuai</creator><creator>Gu, Guoqiang</creator><creator>Luo, Jianjun</creator><creator>Yan, Zhiping</creator><general>Elsevier B.V</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-4942-0439</orcidid></search><sort><creationdate>20240801</creationdate><title>Reduced risk of overt hepatic encephalopathy and death after transjugular intrahepatic portosystemic shunt in patients with hepatic venovenous communications</title><author>Ma, Li ; Ma, Jingqin ; Zhang, Wen ; Yu, Jiaze ; Zhang, Zihan ; Yang, Minjie ; Zhou, Yongjie ; Ju, Shuai ; Gu, Guoqiang ; Luo, Jianjun ; Yan, Zhiping</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c309t-48116ee74ba2083854b5ad529a8260297d8e5d22f68e5caf4c7b6bb7522ad5c53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Bile acids</topic><topic>Decompensated cirrhosis</topic><topic>Intrahepatic shunting</topic><topic>Intrahepatic vascular remodeling</topic><topic>Portal hypertension</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ma, Li</creatorcontrib><creatorcontrib>Ma, Jingqin</creatorcontrib><creatorcontrib>Zhang, Wen</creatorcontrib><creatorcontrib>Yu, Jiaze</creatorcontrib><creatorcontrib>Zhang, Zihan</creatorcontrib><creatorcontrib>Yang, Minjie</creatorcontrib><creatorcontrib>Zhou, Yongjie</creatorcontrib><creatorcontrib>Ju, Shuai</creatorcontrib><creatorcontrib>Gu, Guoqiang</creatorcontrib><creatorcontrib>Luo, Jianjun</creatorcontrib><creatorcontrib>Yan, Zhiping</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of radiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ma, Li</au><au>Ma, Jingqin</au><au>Zhang, Wen</au><au>Yu, Jiaze</au><au>Zhang, Zihan</au><au>Yang, Minjie</au><au>Zhou, Yongjie</au><au>Ju, Shuai</au><au>Gu, Guoqiang</au><au>Luo, Jianjun</au><au>Yan, Zhiping</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Reduced risk of overt hepatic encephalopathy and death after transjugular intrahepatic portosystemic shunt in patients with hepatic venovenous communications</atitle><jtitle>European journal of radiology</jtitle><addtitle>Eur J Radiol</addtitle><date>2024-08-01</date><risdate>2024</risdate><volume>177</volume><spage>111554</spage><pages>111554-</pages><artnum>111554</artnum><issn>0720-048X</issn><issn>1872-7727</issn><eissn>1872-7727</eissn><abstract>[Display omitted]
•Hepatic venovenous communications (HVVC) affect the assessment of portal hypertension.•Presence of HVVC implies better-preserved effective intrahepatic perfusion.•HVVC indicates a favorable prognosis after transjugular intrahepatic portosystemic shunt.
Hepatic venovenous communications (HVVC) is detectable in more than one-third of cirrhotic patients, where portal hypertension (PHT) tends to present more severely. We aimed to explore the prognostic implications of HVVC in patients with sinusoidal PHT treated by transjugular intrahepatic portosystemic shunt (TIPS).
The multicenter data of patients (2020–2022) undergoing balloon-occluded hepatic venography during TIPS were retrospectively analyzed. Pre-TIPS total bile acids (TBA) levels in portal, hepatic and peripheral veins were compared between groups. The primary endpoint was the development of overt hepatic encephalopathy (HE) within one year after TIPS.
183 patients were eligible and classified by the presence (n = 69, 37.7 %) or absence (n = 114, 62.3 %) of HVVC. The agreement between wedged hepatic venous pressure and portal venous pressure was poor in HVVC group (intraclass correlation coefficients [ICC]: 0.141, difference: 13.4 mmHg, p < 0.001), but almost perfect in non-HVVC group (ICC: 0.877, difference: 0.4 mmHg, p = 0.152). At baseline, patients with HVVC had lower Model for end-stage liver disease scores (p < 0.001), blood ammonia levels (p < 0.001), TBA concentrations in the hepatic (p = 0.011) and peripheral veins (p = 0.049) rather than in the portal veins (p = 0.516), and a higher portosystemic pressure gradient (p = 0.035), suggesting more effective intrahepatic perfusion in this group. Within 1-year post-TIPS, HVVC group had a lower incidence of overt HE (11.7 % vs. 30.5 %, p = 0.004, HR: 0.34, 95 % CI: 0.16–0.74, absolute risk difference [ARD]: −17.4) and an improved liver transplantation-free survival rate (97.1 % vs. 86.8 %, p = 0.021, HR: 0.16, 95 % CI: 0.05–0.91, ARD: −10.3).
For patients with sinusoidal PHT treated by TIPS, the presence of HVVC was associated with a reduced risk of overt HE and a potential survival benefit.</abstract><cop>Ireland</cop><pub>Elsevier B.V</pub><pmid>38850724</pmid><doi>10.1016/j.ejrad.2024.111554</doi><orcidid>https://orcid.org/0000-0003-4942-0439</orcidid></addata></record> |
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| source | Elsevier ScienceDirect Journals |
| subjects | Bile acids Decompensated cirrhosis Intrahepatic shunting Intrahepatic vascular remodeling Portal hypertension |
| title | Reduced risk of overt hepatic encephalopathy and death after transjugular intrahepatic portosystemic shunt in patients with hepatic venovenous communications |
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