Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 14, 2021; 27(30): 5088-5099
Published online Aug 14, 2021. doi: 10.3748/wjg.v27.i30.5088
Clinical efficacy of antiviral therapy in patients with hepatitis B-related cirrhosis after transjugular intrahepatic portosystemic shunt
Xin Yao, Shan Huang, Hao Zhou, Shan-Hong Tang, Jian-Ping Qin
Xin Yao, Shan Huang, Shan-Hong Tang, Jian-Ping Qin, Department of Gastroenterology, General Hospital of Western Theater Command, Chengdu 610083, Sichuan Province, China
Hao Zhou, Department of Gastroenterology, Fengjie County People's Hospital, Chongqing 404600, China
Author contributions: Yao X performed the operation and wrote the paper; Zhou H performed the operation and collected the data; Tang SH collected and analyzed the data; Huang S performed the operation and analyzed the data; Qin JP participated in and guided the operation and finalized the manuscript.
Institutional review board statement: This study was approved by the Hospital Ethics Committee.
Informed consent statement: Patients and their families were fully informed and provided signed consent for surgery.
Conflict-of-interest statement: The authors declare no competing interests for this manuscript.
Data sharing statement: The study protocol, statistical analysis plan, and de-identified participant data can be made available upon request for non-commercial purposes and after approval of a study proposal through a signed data access agreement. Proposals should be directed to jpqqing@163.com.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jian-Ping Qin, MD, Doctor, Department of Gastroenterology, General Hospital of Western Theater Command, No. 270 Rongdu Road, Chengdu 610083, Sichuan Province, China. jpqqing@163.com
Received: April 7, 2021
Peer-review started: April 7, 2021
First decision: May 27, 2021
Revised: May 28, 2021
Accepted: July 15, 2021
Article in press: July 15, 2021
Published online: August 14, 2021
Abstract
BACKGROUND

As a country with a high burden of hepatitis B, China has about 86 million cases of hepatitis B virus infection, ranking the first in the world. Currently, there are about 390000 deaths due to hepatitis B-related complications such as liver cirrhosis and liver cancer every year. Consequently, how to control portal hypertension, improve liver functional reserve, and reduce the incidence of hepatic failure and liver cancer in such patients is the focus of current clinical attention. Previous clinical study in our center suggested that at 24 mo after transjugular intrahepatic portosystemic shunt (TIPS), the liver functional reserve of patients with hepatitis B cirrhosis was better than that of patients with alcohol-induced and immune cirrhosis, which may be related to the effective etiological treatment.

AIM

To investigate the clinical efficacy of three first-line antiviral drugs recommended by the guidelines of prevention and treatment for chronic hepatitis B in China (2019) in the treatment of patients with hepatitis B-related cirrhosis who had received a TIPS.

METHODS

The clinical data of 137 patients with hepatitis B-related cirrhosis with portal hypertension after receiving TIPS at our centre between March 2016 and December 2020 were analysed retrospectively. According to different anti-viral drugs, the patients were divided into entecavir (ETV) (n = 70), tenofovir alafenamide fumarate (TAF) (n = 32), and tenofovir disoproxil fumarate (TDF) (n = 35) groups. The cumulative incidence of hepatic encephalopathy and hepatocellular carcinoma, survival, and changes in hepatic reserve function and glomerular filtration rate in patients treated with different antiviral drugs within 24 mo after surgery were investigated.

RESULTS

At 24 mo after surgery, the Child–Pugh score in the TAF group (6.97 ± 0.86) was lower than that in the TDF (7.49 ± 0.82; t = -2.52, P = 0.014) and ETV groups (7.64 ± 1.17; t = -2.92, P = 0.004). The model for end-stage liver disease score in the TAF group at 24 mo after surgery was 9.72 ± 1.5, which was lower than that in the TDF (10.74 ± 2.33; t = -2.09, P = 0.040) and ETV groups (10.97 ± 2.17; t = -2.93, P = 0.004). At 24 mo after surgery, the estimated glomerular filtration rate (eGFR) in the TAF group (104.41 ± 12.54) was higher than that in the TDF (93.54 ± 8.97) and ETV groups (89.96 ± 9.86) (F = 21.57, P < 0.001).

CONCLUSION

At 24 mo after surgery, compared with TDF and ETV, TAF has significant advantages in the improvement of liver functional reserve and eGFR.

Keywords: Transjugular intrahepatic portosystemic shunt, Hypertension, Antiviral, Hepatitis B-related cirrhosis, Liver reserve function

Core Tip: As a country with a high burden of hepatitis B, China has about 86 million cases of hepatitis B virus (HBV) infection, ranking the first in the world. Hepatitis B cirrhosis complicated with portal hypertension is characterized by persistent HBV replication and aggravated liver inflammation and fibrosis. Considering the fact that there is currently no report on the clinical efficacy of antiviral therapy for patients with hepatitis B cirrhosis after transjugular intrahepatic portosystemic shunt, we believe that this study has appreciated clinical reference value for the selection of anti-HBV drugs in such patients.