Retrospective Cohort Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Mar 27, 2025; 17(3): 103261
Published online Mar 27, 2025. doi: 10.4254/wjh.v17.i3.103261
Effect of portal pressure gradient reduction on outcomes after transjugular intrahepatic portosystemic shunt in portal hypertension patients
Zhi-Bin Wang, Bing Zhu, Ming-Ming Meng, Yi-Fan Wu, Yu Zhang, Dong-Ze Li, Hua Tian, Fu-Chuan Wang, Yi-Fan Lv, Qiu-Xia Ye, Fu-Quan Liu
Zhi-Bin Wang, Ming-Ming Meng, Yi-Fan Wu, Yu Zhang, Yi-Fan Lv, Qiu-Xia Ye, Fu-Quan Liu, Center for Minimally Invasive Treatment of Liver Diseases, Beijing Shijitan Hospital, Capital Medical University, Beijing 100080, China
Bing Zhu, Dong-Ze Li, Hua Tian, Fu-Chuan Wang, Fu-Quan Liu, Center for Diagnosis and Treatment of Hepatic Vascular Diseases, The Fifth Medical Center of Chinese People’s Liberation Army General Hospital, Beijing 100071, China
Author contributions: Wang ZB, Zhu B, Meng MM, and Wu YF contributed to the study design and data collection; Zhang Y and Li DZ performed data analysis; Tian H, Wang FC, Lv YF, and Ye QX assisted with result interpretation; Liu FQ supervised the study and is the corresponding author; and all authors reviewed and approved the final manuscript.
Supported by the “14th Five-Year” Talent Training Program of Beijing Shijitan Hospital, Capital Medical University, No. 2023 LJRCLFQ.
Institutional review board statement: This retrospective cohort study received approval from the Institutional Review Boards of Beijing Shijitan Hospital, Capital Medical University, and the Fifth Medical Center of the Chinese People’s Liberation Army General Hospital (No. KY-2023-12-83-1).
Informed consent statement: Patients were not required to provide informed consent for this study because the analysis used anonymous clinical data that were obtained after patient had agreed to treatment with written consent.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: sharing statement: The datasets generated and analyzed during the current study are not publicly available due to patient confidentiality and privacy concerns but are available from the corresponding author upon reasonable request and with permission from the Institutional Review Boards of Beijing Shijitan Hospital, Capital Medical University, and the Fifth Medical Center of the Chinese People’s Liberation Army General Hospital.
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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Fu-Quan Liu, MD, Professor, Center for Minimally Invasive Treatment of Liver Diseases, Beijing Shijitan Hospital, Capital Medical University, No. 10 Tieyi Road, Yangfangdian, Haidian district, Beijing 100080, China. lfuquan@aliyun.com
Received: November 14, 2024
Revised: February 1, 2025
Accepted: March 4, 2025
Published online: March 27, 2025
Processing time: 132 Days and 18 Hours
Abstract
BACKGROUND

Portal hypertension (PHT), a complication of liver cirrhosis, is sometimes managed with transjugular intrahepatic portosystemic shunt (TIPS) to reduce portal pressure. Although effective, TIPS poses risks, including hepatic encephalopathy (HE). This study investigates whether a significant reduction in the portal pressure gradient (PPG) after TIPS improves outcomes in PHT patients.

AIM

To evaluate the impact of post-TIPS PPG reduction on clinical outcomes and explore the relationship between PPG reduction and portal vein diameter.

METHODS

This retrospective cohort study included 815 patients with PHT who underwent TIPS at two tertiary hospitals between 2014 and 2022. Patients were categorized based on whether they achieved a 50% reduction in PPG. Propensity score matching was applied to balance baseline characteristics. Kaplan-Meier analysis assessed clinical outcomes, including rebleeding, HE, liver failure, and hepatocellular carcinoma. Cox regression identified risk factors, and Spearman correlation analyzed the relationship between PPG reduction and portal vein diameter.

RESULTS

Patients with a PPG reduction > 50% had significantly lower risks of rebleeding (P = 0.004), shunt dysfunction (P = 0.002), and mortality (P = 0.024) compared to those with a PPG reduction ≤ 50%. However, these patients faced higher risks of HE (P < 0.001) and liver failure (P = 0.003). A significant negative correlation was observed between the percentage of PPG reduction and portal vein diameter (ρ = -0.632, P < 0.001), suggesting that patients with smaller portal vein diameters may achieve greater PPG reductions.

CONCLUSION

A significant PPG reduction following TIPS is associated with improved clinical outcomes, including reduced risks of rebleeding, shunt dysfunction, hepatocellular carcinoma, and mortality, though it increases HE and liver failure risks. The observed correlation between portal vein diameter and PPG reduction highlights the potential role of portal vein anatomy in predicting TIPS efficacy, warranting further investigation.

Keywords: Liver cirrhosis; Portal hypertension; Transjugular intrahepatic portosystemic shunt; Hepatic encephalopathy; Liver failure; Carcinoma; Hepatocellular

Core Tip: This study evaluates the impact of portal pressure gradient (PPG) reduction following transjugular intrahepatic portosystemic shunt (TIPS) on clinical outcomes in portal hypertension patients. Findings reveal that a significant PPG reduction (> 50%) post-TIPS is linked to decreased risks of rebleeding, shunt dysfunction, hepatocellular carcinoma, and mortality. However, it also raises the risk of hepatic encephalopathy and liver failure. Additionally, portal vein diameter influences the degree of PPG reduction. These insights highlight the need for personalized management strategies to optimize TIPS outcomes, balancing benefits and potential risks for improved patient prognosis.