Mauz Jim B, Rieland Hannah, Berliner Dominik, Tiede Anja, Stockhoff Lena, Hinrichs Jan B, Wedemeyer Heiner, Meyer Bernhard C, Olsson Karen M, Maasoumy Benjamin, Tergast Tammo L
Hannover Medical School, Department of Gastroenterology, Hepatology, Infectious Diseases, and Endocrinology, Hannover, Germany.
Hannover Medical School, Department of Cardiology and Angiology, Hannover, Germany.
Clin Gastroenterol Hepatol. 2024 Sep;22(9):1867-1877.e4. doi: 10.1016/j.cgh.2024.04.027. Epub 2024 May 9.
BACKGROUND & AIMS: Considerate patient selection is vital to ensure the best possible outcomes after transjugular intrahepatic portosystemic shunt (TIPS) insertion. However, data regarding the impact of intrapulmonary vascular dilatations (IPVDs) or hepatopulmonary syndrome (HPS) on the clinical course after TIPS implantation is lacking. Hence, this study aimed to investigate the relevance of IPVD and HPS in patients undergoing TIPS implantation.
Contrast enhanced echocardiography and blood gas analysis were utilized to determine presence of IPVD and HPS. Multivariable competing risk analyses were performed to evaluate cardiac decompensation (CD), hepatic decompensation (HD), and liver transplant (LTx)-free survival within 1 year of follow-up.
Overall, 265 patients were included, of whom 136 had IPVD and 71 fulfilled the HPS criteria. Patients with IPVD had lower Freiburg index of post-TIPS survival (FIPS) scores, lower creatinine, and more often received TIPS because of variceal bleeding. Presence of IPVD was associated with a significantly higher incidence of CD (hazard ratio [HR], 1.756; 95% confidence interval [CI], 1.011-3.048; P = .046) and HD (HR, 1.841; 95% CI, 1.255-2.701; P = .002). However, LTx-free survival was comparable between patients with and without IPVD (HR, 1.081; 95% CI, 0.630-1.855; P = .780). Patients with HPS displayed a trend towards more CD (HR, 1.708; 95% CI, 0.935-3.122; P = .082) and HD (HR, 1.458; 95% CI, 0.934-2.275; P = .097) that failed to reach statistical significance. LTx-free survival did not differ in those with HPS compared with patients without HPS, respectively (HR, 1.052; 95% CI, 0.577-1.921; P = .870).
Screening for IPVD before TIPS implantation could help to further identify patients at higher risk of CD and HD.
谨慎选择患者对于确保经颈静脉肝内门体分流术（TIPS）植入术后获得最佳预后至关重要。然而，关于肺内血管扩张（IPVD）或肝肺综合征（HPS）对TIPS植入术后临床病程影响的数据尚缺乏。因此，本研究旨在探讨IPVD和HPS在接受TIPS植入术患者中的相关性。
采用对比增强超声心动图和血气分析来确定IPVD和HPS的存在情况。进行多变量竞争风险分析以评估随访1年内的心衰（CD）、肝衰（HD）和无肝移植（LTx）生存情况。
总共纳入265例患者，其中136例有IPVD，71例符合HPS标准。有IPVD的患者TIPS术后生存弗赖堡指数（FIPS）评分较低，肌酐水平较低，且因静脉曲张出血而接受TIPS的情况更常见。IPVD的存在与CD（风险比[HR]，1.756；95%置信区间[CI]，1.011 - 3.048；P = 0.046）和HD（HR，1.841；95% CI，1.255 - 2.701；P = 0.002）的发生率显著升高相关。然而，有和没有IPVD的患者无LTx生存情况相当（HR，1.081；95% CI，0.630 - 1.855；P = 0.780）。有HPS的患者出现CD（HR，1.708；95% CI，0.935 - 3.122；P = 0.082）和HD（HR，1.458；95% CI，0.934 - 2.275；P = 0.097）的趋势，但未达到统计学显著性。有HPS的患者与无HPS的患者相比，无LTx生存情况无差异（HR，1.052；95% CI，0.577 - 1.921；P = 0.870）。
在TIPS植入术前筛查IPVD有助于进一步识别发生CD和HD风险较高的患者。
