Department of Radiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany.
Department of Radiology, University of Wisconsin, Madison, WA, USA.
Cardiovasc Intervent Radiol. 2023 Sep;46(9):1203-1213. doi: 10.1007/s00270-023-03520-z. Epub 2023 Aug 2.
The purpose of the study was to investigate outcome after pediatric transjugular intrahepatic portosystemic shunt (TIPS) with respect to survival MATERIAL AND METHODS: After searching for studies on TIPS in children in Ovid, Medline, Embase, Scopus and Cochrane published between 2000 and 2022, individual patient data were retrieved from five retrospective cohorts. Overall survival (OS) and transplant-free survival (TFS) were calculated using Kaplan-Meier analysis and log-rank test and compared to the indication (ascites vs. variceal bleeding) as well as to the level of obstruction (pre-hepatic vs. hepatic vs. post-hepatic). Additionally, TIPS patency was analyzed.
n = 135 pediatric patients were included in the final analysis. Indication for pediatric TIPS creation was heterogeneous among the included studies. TIPS patency decreased from 6 to 24 months, subsequent pediatric liver transplantation was performed in 22/135 (16.3%) of cases. The presence of ascites was related with poorer TFS (HR 2.3, p = 0.023), while variceal bleeding was not associated with impaired survival. Analysis of the level of obstruction (pre-hepatic, hepatic and post-hepatic) failed to prove significantly reduced OS for post-hepatic obstruction (HR 3.2, p = 0.092) and TFS (HR 1.3, p = 0.057). There was no difference in OS and TFS according to age at time of TIPS placement.
The presence of ascites associates with impaired survival after TIPS in children, with no differences in survival according to the age of the child. Interventional shunt procedures can be considered feasible for all ages.
Level 2a.
本研究旨在探讨儿童经颈静脉肝内门体分流术（TIPS）的预后，包括生存率。
在 Ovid、Medline、Embase、Scopus 和 Cochrane 中搜索 2000 年至 2022 年期间发表的关于儿童 TIPS 的研究后，从五个回顾性队列中提取了个体患者数据。使用 Kaplan-Meier 分析和对数秩检验计算总生存率（OS）和无移植生存率（TFS），并将其与适应证（腹水与静脉曲张出血）以及梗阻水平（肝前、肝内与肝后）进行比较。此外，还分析了 TIPS 的通畅性。
最终分析纳入了 135 例儿科患者。纳入研究中，儿童 TIPS 适应证存在异质性。TIPS 通畅性从 6 个月到 24 个月逐渐下降，随后 22/135（16.3%）例患者进行了儿童肝移植。腹水的存在与较差的 TFS 相关（HR 2.3，p=0.023），而静脉曲张出血与生存率下降无关。梗阻水平（肝前、肝内与肝后）分析未能证明肝后梗阻与 OS（HR 3.2，p=0.092）和 TFS（HR 1.3，p=0.057）显著降低相关。TIPS 放置时的年龄与 OS 和 TFS 无差异。
腹水的存在与儿童 TIPS 后生存率下降相关，而儿童的年龄与生存率无差异。介入性分流术可考虑适用于所有年龄段。
2a 级。
