In:
Journal of Gastroenterology and Hepatology, Wiley, Vol. 36, No. 10 ( 2021-10), p. 2893-2902
Abstract:
Patients indicated to transjugular intrahepatic portosystemic shunt (TIPS) placement may have splenectomy history due to thrombocytopenia. This study aimed to evaluate the effect of prior splenectomy on TIPS procedure and post‐TIPS outcomes. Methods We conducted a longitudinal analysis based on a cohort of 284 patients with cirrhosis submitted to TIPS; 74 patients had splenectomy history (splenectomy group) and 210 did not (non‐splenectomy group). Cox proportional hazards models were used to evaluate the association between splenectomy and outcomes after TIPS. The primary outcome was shunt dysfunction. Secondary outcomes included all‐cause mortality, clinical recurrence of bleeding or ascites, and overt hepatic encephalopathy (OHE). Results During a median follow‐up of 16.2 months, the splenectomy group had significantly lower rates of postoperative shunt patency (85.5% vs 95.6% at 1 year and 75.2% vs 86.5% at 2 years; adjusted hazard ratio [HR] 2.53; 95% confidence interval [CI] 1.21–5.12; P = 0.01) and higher risk of OHE (adjusted HR 1.82; 95% CI 1.03–3.54; P = 0.04). But the risk of mortality (adjusted HR 0.87; 95% CI 0.41–1.87; P = 0.73) and recurrent bleeding or ascites (adjusted HR 1.17; 95% CI 0.53–2.35; P = 0.77) showed no statistical difference. Multivariate analysis confirmed splenectomy history and endoscopic therapy as independent predictors of shunt dysfunction. Besides, pre‐TIPS splenectomy increased the difficulty of TIPS procedure by complicating portal vein puncture. Conclusions For patients with cirrhosis submitted to TIPS, prior splenectomy complicated TIPS procedure and increased the risk of shunt dysfunction and OHE after TIPS, but was not significantly associated with the occurrence of mortality and recurrent bleeding or ascites.
Type of Medium:
Online Resource
ISSN:
0815-9319
,
1440-1746
Language:
English
Publisher:
Wiley
Publication Date:
2021
detail.hit.zdb_id:
2006782-3
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