Published online Aug 14, 2021. doi: 10.3748/wjg.v27.i30.5088
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
Processing time: 124 Days and 15.9 Hours
Hepatitis B cirrhosis complicated with portal hypertension is characterized by persistent hepatitis B virus (HBV) replication and aggravated liver inflammation and fibrosis. Without timely control, it may progress to severe post-cirrhosis complications such as esophagogastric variceal bleeding, hepatic encephalopathy (HE), intractable hydrothorax and ascites, and even hepatic failure and liver cancer, leading to death. Consequently, how to control portal hypertension, improve liver functional reserve, and reduce the incidences of hepatic failure and liver cancer in such patients is the focus of current clinical attention. Previous clinical study in our center suggested that the use of an 8-mm stent during transjugular intrahepatic portosystemic shunt (TIPS) could not only effectively shunt, but also relieve portal pressure. Twenty-four months after surgery, the liver functional reserve of patients with hepatitis B cirrhosis was better than that of patients with alcohol-induced and immune cirrhosis. Based on the above studies, the clinical data of patients with hepatitis B cirrhosis after TIPS treated with different antiviral drugs were retrospectively analyzed in this study.
TIPS is an effective minimally invasive interventional method for the treatment of portal hypertension-related complications. It is worthy of further clinical exploration on the management of patients with hepatitis B cirrhosis using individualized antiviral therapy after surgery. Considering the fact that there is no report on the clinical efficacy of antiviral therapy for patients with hepatitis B cirrhosis after TIPS, we believe that this study has appreciated clinical reference value for the selection of anti-HBV drugs in such patients.
To explore the clinical efficacy of the three antiviral drugs through this retrospective study, so as to provide reference for antiviral treatment of patients with chronic hepatitis B (CHB) cirrhosis after TIPS.
The clinical data of 137 patients with hepatitis B-related cirrhosis with portal hypertension after receiving TIPS at our center 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 HE and hepatocellular carcinoma (HCC), 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.
At 24 mo after surgery, compared with TDF and ETV, TAF had significant advantages in the improvement of liver functional reserve and estimated glomerular filtration rate (eGFR).
Through clinical practice, compared with TDF and ETV, TAF has significant advantages in the improvement of liver functional reserve and eGFR. The difference in the long-term effect of TAF on HCC occurrence needs further observation and clarification. The author’s team believes that improving the long-term survival rate of patients with hepatitis B cirrhosis after TIPS involves a complex situation, which is determined by a large number of non-hemodynamic factors. Early initiation of antiviral therapy and optimization of antiviral therapy are important factors. Age, degree of renal failure, chronic inflammation, urease-producing intestinal bacteria, bacterial translocation, and malnutrition/atrophy are other very important factors in the regulation of the treatment.
The difference in the long-term effect of TAF on HCC occurrence needs further observation and clarification.