Published online Mar 6, 2021. doi: 10.12998/wjcc.v9.i7.1532
Peer-review started: July 28, 2020
First decision: November 23, 2020
Revised: December 7, 2020
Accepted: December 23, 2020
Article in press: December 23, 2020
Published online: March 6, 2021
As transjugular intrahepatic portosystemic shunt (TIPS) creation alters the hemodynamic status of the portal system, whether reduced portal blood supply affects the synthetic reserve function of the liver has been the focus of clinical attention.
Early clinical studies were based on the Fluency stents in establishing a shunt in the portal vein; stents should be placed in the portal vein so that sufficient length remains for the stent to shunt blood from the portal trunk, and affect portal vein branch blood supply. The Viatorr stent can be used to establish a TIPS shunt channel, where the bare stent region is established in a branch of the portal vein, to ensure smooth blood flow in the portal vein and avoid excess blood that has not passed directly through the liver entering the systemic circulation. Since the Viatorr stent entered the Chinese market in 2015, it has not yet been widely used in clinical practice. Further, unlike other countries, the main cause of liver cirrhosis in China is viral hepatitis. Therefore, use of the Viatorr stent to establish a TIPS channel in patients with liver cirrhosis with differing etiologies is of great clinical interest.
The purpose of this study was to investigate factors affecting changes in liver reserve function after TIPS Viatorr stent implantation, and to find ways to reduce the occurrence of liver failure and improve long-term survival rates.
Clinical data from 200 patients with cirrhotic portal hypertension who received TIPS treatment from March 2016 to March 2020 were analyzed retrospectively. The patients were divided into three groups (A-C), according to their disease etiology, with post-hepatitis, autoimmune, and alcoholic cirrhosis, respectively. Preoperative and postoperative liver and renal function and coagulation data, Child-Pugh class, and model for end-stage liver disease (MELD) scores were collected. Statistical analyses were performed using the t-test or chi-square test. The incidence of hepatic encephalopathy and patient survival were calculated using the Kaplan-Meier method.
The surgical success rate was 100%, with mean portal pressure gradient (mmHg) decreasing from 25.5 ± 5.22 to 10.04 ± 2.76 (t = 45.80; P < 0.001). After 24 mo, the cumulative incidence of hepatic encephalopathy in group A was significantly lower than that in group B/C, while the cumulative survival rate was significantly higher in group A than in group B/C (P < 0.0.5 for both). The Child-Pugh score for group A was 6.96 ± 1.21, which was significantly better than those of groups B (7.42 ± 0.99; t = -2.44; P = 0.016) and C (7.52 ± 1.12; t = -2.67; P = 0.009). Further, the MELD score for group A (9.62 ± 2.19) was significantly better than those for groups B (10.64 ± 1.90; t = -2.92; P = 0.004) and C (10.82 ± 2.01; t = -3.29; P = 0.001).
Insertion of a Viatorr stent with an internal diameter of 8 mm has no significant effects on liver reserve function.
Changes of liver reserve function in the medium and long term may be related to the etiology and treatment of portal hypertension.