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TIPS safe, effective in patients with idiopathic noncirrhotic portal hypertension

Transjugular intrahepatic portosystemic shunts were safe and effective in treating the complications of patients with idiopathic noncirrhotic portal hypertension who had normal kidney function and no severe extrahepatic conditions, according to recent findings published in Hepatology.

“The main finding in this study is an excellent outcome of TIPS in patients who had no significant extrahepatic comorbidities,” the researchers wrote. “Despite the retrospective nature of this work, we believe that this cohort was representative of [idiopathic noncirrhotic portal hypertension (INCPH)] as histological diagnosis was confirmed in all patients, common causes of liver diseases and cirrhosis were excluded, and the various associated extrahepatic comorbidities were comparable to those in previous reports.”

INCPH is defined as portal hypertension (PHT) without cirrhosis, venous obstruction and a cause of chronic liver disease, the researchers wrote. Due to a lack of data concerning management of INCPH, current recommendations indicate to treat them the same as for patients with cirrhosis, which includes the use of transjugular portosystemic shunt (TIPS). To validate this recommendation, the researchers aimed to retrospectively investigate the outcome of patients with INCPH treated with TIPS.

The researchers reviewed charts of 41 patients who were initially assessed between 2000 and 2014. The indications for TIPS were recurrent variceal bleeding (n = 25) and refractory ascites (n= 16). Patients were grouped based on the presence (n = 27) or absence (n = 14) of extrahepatic comorbidities, which were hematologic, prothrombotic, neoplastic, immune and exposure to toxins. The average time of follow up was 27 months.

At follow-up, variceal bleeding re-occurred in seven of 25 patients, including three with early thrombosis of the stent. Post-TIPS overt hepatic encephalopathy occurred in 14 of 41 patients. The TIPS procedure was completed with hemoperitoneum in four patients and was fatal in 1 case. Overall, 11 patients died. Death was associated with ascites (P = .04), serum creatinine (P = .005), and the presence of significant comorbidities at the time of procedure (P = .01). Further, mortality occurred in more patients who had significant comorbidities and a creatinine level of at least 100 µmol/L (P < .001).

This is the largest study to focus on the use of TIPS in treating PHT complications in patients with INCPH, the researchers wrote.

“In patients with INCPH who have preserved renal function or do not have severe extrahepatic conditions, TIPS is an excellent alternative to treat severe complications of PHT,” the researchers wrote. “Further studies are needed to better understand the interplay and impact of extrahepatic comorbidities on the natural history of INCPH.” – by Will Offit

Disclosure: Bissonnette reports receiving speaker fees from Gore. Please see the full study for a list of all other researchers’ relevant financial disclosures.