First experience of transjugular intrahepatic portosystemic shunting at multidisciplinary hospital with a liver transplantation program

Aim: Analysis of the first experience of transjugular intrahepatic portosystemic shunting (TIPS) in patients with liver cirrhosis at a multidisciplinary hospital with a liver transplantation program.

Materials and methods: The authors examined 206 patients with liver cirrhosis from July 2019 to June 2021, with 20 of them undergoing TIPS. The mean age of the patients was 47.59 ± 9.55 years (35–65 years). Dynamic follow-up was performed at 3, 6, 9, 12, and 18 months. As a part of the dynamic follow-up, the patients underwent laboratory tests, abdomen ultrasound examination, and computed tomography imaging enhanced by the intravenous use of contrasting agent, endoscopy, esophagogastroduodenoscopy, and encephalopathy assessment.

Results: No in-hospital TIPS-associated mortality has been reported. Two patients died in the hospital at the 19th and 26th day following the surgery because of the progression of liver failure, the 6-week mortality rate was 10%. In one patient (5%), an intraoperative complication was reported, i.e., intra-abdominal hemorrhage secondary to the migration of the stent under the liver capsule. The length of hospital stay after surgery was 7.34 ± 1.89 days (5–26 days). Long-term outcomes were available for 17 patients. The duration of the dynamic follow-up was 13.23 ± 2.47 months (3–24 months) and 2 (11,7%) deaths were reported. One patient (5.8%) was diagnosed with a shunt thrombosis at 12 months after the surgery. Three patients underwent liver transplantation after TIPS. The current one-year survival rate is 90%.

Conclusion: TIPS is a safe and effective procedure decreasing mortality and improving quality of life of patients awaiting cadaveric liver transplantation. TIPS should be widely implemented in multidisciplinary hospitals having liver transplant program.

1. Asrani S.K., Devarbhavi H., Eaton J., Kamath P.S. Burden of liver diseases in the world. J. Hepatol. 2019; 70 (1): 151–171. https://doi.org/10.1016/j.jhep.2018.09.014

2. Roberts D., Best L.M., Freeman S.C., Sutton A.J., Cooper N.J., Arunan S., Begum T., Williams N.R., Walshaw D., Milne E.J., Tapp M., Csenar M., Pavlov C.S., Davidson B.R., Tsochatzis E., Gurusamy K.S. Treatment for bleeding oesophageal varices in people with decompensated liver cirrhosis: a network metaanalysis. Cochrane Database Syst. Rev. 2021; 4 (4): CD013155. https://doi.org/10.1002/14651858.CD013155.pub2

3. Eramishantsev A.K., Sherzinger A.G., Kitsenko E.A. Portal hypertension. Klinicheskaya khirurgiya: natsional'noye rukovodstvo [Clinical Surgery: National Guidelines]. Moscow: GEOTAR-Media, 2008. P. 626–665. (In Russian)

4. Mosharova A.A., Vertkin A.L. Treatment and prevention of bleeding from varicose veins of the esophagus. Neotlozhnaya terapiya. 2012; 1–2: 12–19. (In Russian)

5. Pomier-Layrargues G., Bouchard L., Lafortune M., Bissonnette J., Guérette D., Perreault P. The transjugular intrahepatic portosystemic shunt in the treatment of portal hypertension: current status. Int. J. Hepatol. 2012; 12 (6): 352–358. https://doi.org/10.1155/2012/167868

6. Gluud L.L., Klingenberg S., Nikolova D., Gluud C. Banding ligation versus b-blockers as primary prophylaxis in esophageal varices: systematic review of randomized trials. Am. J. Gastroenterol. 2007; 102 (12): 2842–2848. https://doi.org/10.1111/j.1572-0241.2007.01564.x.

7. Amitrano L., Guardascione M.A., Manguso F., Bennato R., Bove A., DeNucci C., Lombardi G., Martino R., Menchise A., Orsini L., Picascia S., Riccio E. The effectiveness of current acute variceal bleed treatments in unselected cirrhotic patients: refining short-term prognosis and risk factors. Am. J. Gastroenterol. 2012; 107 (12): 1872–1878. https://doi.org/10.1038/ajg.2012.313

8. Philips C.A., Rajesh S., George T., Betgeri S.S., Mohanan M., Augustine P. Transjugular-intrahepatic portosystemic shunt placement at first portal hypertensive decompensation (veryearly or “anticipant tips”) compared to conventional tips and standard medical treatment in patients with cirrhosis. Gastroenterology. 2020; 158 (6): S-128. https://doi.org/10.1016/S0016-5085(20)33907-X

9. Sherzinger A.G., Zhao A.V., Ivashkin V.T., Mayevskaya M.V., Pavlov Ch.S., Vertkin A.L., Ogurtsov P.P., Lopatkina T.N., Kotiv B.N., Dzidzawa I.I., Anisimov A.Yu., Prudkov M.I., Khoronko Yu.V., Nazyrov F.G., Devyatov A.V., Kitsenko E.A. Treatment of bleeding from varicose veins of the esophagus and stomach. Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery. 2013; 18 (3): 110–129. (In Russian)

10. Anisimov A.Yu., Vertkin A.L., Devyatov A.V., Dzidzava I.I., Ivashkin V.T., Kitsenko E.A., Kotiv B.N., Lopatkina T.N., Maevskaya M.V., Nazyrov F.G., Ogurtsov P.P., Pavlov Ch.S., Prudkov M.I., Khoronko Yu.V., Zhao A.V., Sherzinger A.G. Practical guidelines for treatment of bleeding from varicose veins of the esophagus and stomach. Moscow Surgical Journal. 2013; 6 (34): 41–54. (In Russian)

11. Rajesh S., George T., Philips C.A., Ahamed R., Kumbar S., Mohan N., Mohanan M., Augustine P. Transjugular intrahepatic portosystemic shunt in cirrhosis: an exhaustive critical update. World J. Gastroenterol. 2020; 26 (37): 5561–5596. https://doi.org/10.3748/wjg.v26.i37.5561

12. Baveno VI Faculty. Expanding consensus in portal hypertension: Report of the Baveno VI Consensus Workshop: Stratifying risk and individualizing care for portal hypertension. J. Hepatol. 2015; 63 (3): 743–752. https://doi.org/10.1016/j.jhep.2015.05.022

13. Tripathi D., Stanley A.J., Hayes P.C., Travis S., Armstrong M.J., Tsochatzis E.A., Rowe I.A., Roslund N., Ireland H., Lomax M., Leithead J.A., Mehrzad H., Aspinall R.J., McDonagh J., Patch D. Transjugular intrahepatic portosystemic stent-shunt in the management of portal hypertension. Gut. 2020; 69 (7): 1173–1192. https://doi.org/10.1136/gutjnl-2019-320221

14. Zatevakhin I.I., Tsitsiashvili M.Sh., Shipovskiy V.N., Monakhov D.V., Pan A.V. Hepatic encephalopathy in patients with liver cirrhosis before and after TIPS. Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery. 2015; 20 (2): 40–45. https://doi.org/10.16931/1995-5464.2015240-45 (In Russian)

15. Khoronko Yu.V., Kosovtsev E.V., Kozyrevsky M.A., Khoronko E.Yu., Krivorotov N.A., Chesnokov V.V. Portosystemic shunting procedures for complicated portal hypertension: modern opportunities of mini-invasive technique. Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery. 2021; 26 (3): 34–45. https://doi.org/10.16931/1995-5464.2021- 3-34–45 (In Russian)

16. Sauerbruch T., Mengel M., Dollinger M., Zipprich A., Rössle M., Panther E., Wiest R., Caca K., Hoffmeister A., Lutz H., Schoo R., Lorenzen H., Trebicka J., Appenrodt B., Schepke M., Fimmers R.; German Study Group for Prophylaxis of Variceal Rebleeding. Prevention of rebleeding from esophageal varices in patients with cirrhosis receiving small-diameter stents versus hemodynamically controlled medical therapy. Gastroenterology. 2015; 149 (3): 660-8.e1. https://doi. org/10.1053/j.gastro.2015.05.011

17. Holster I.L., Tjwa E.T., Moelker A., Wils A., Hansen B.E., Vermeijden J.R., Scholten P., van Hoek B., Nicolai J.J., Kuipers E.J., Pattynama P.M., van Buuren H.R. Covered transjugular intrahepatic portosystemic shunt vs endoscopic therapy + β-blocker for prevention of variceal rebleeding. Hepatology. 2016; 63 (2): 581–589. https://doi.org/10.1002/hep.28318

18. Plaz Torres M.C., Best L.M., Freeman S.C., Roberts D., Cooper N.J., Sutton A.J., Roccarina D., Benmassaoud A., IognaPrat L., Williams N.R., Csenar M., Fritche D., Begum T., Arunan S., Tapp M., Milne E.J., Pavlov C.S., Davidson B.R., Tsochatzis E., Gurusamy K.S. Secondary prevention of variceal bleeding in adults with previous oesophageal variceal bleeding due to decompensated liver cirrhosis: a network meta-analysis. Cochrane Database Syst. Rev. 2021; 3 (3): CD013122. https://doi.org/10.1002/14651858.CD013122.pub2