Shanghai Institution of Medical Imaging, Fudan University, Shanghai, China; Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.
Center for Tumor Diagnosis and Therapy, Jinshan Hospital, Fudan University, Shanghai, China.
Eur J Radiol. 2024 Aug;177:111554. doi: 10.1016/j.ejrad.2024.111554. Epub 2024 Jun 5.
Hepatic venovenous communications (HVVC) is detectable in more than one-third of cirrhotic patients, where portal hypertension (PHT) tends to present more severely. We aimed to explore the prognostic implications of HVVC in patients with sinusoidal PHT treated by transjugular intrahepatic portosystemic shunt (TIPS).
The multicenter data of patients (2020-2022) undergoing balloon-occluded hepatic venography during TIPS were retrospectively analyzed. Pre-TIPS total bile acids (TBA) levels in portal, hepatic and peripheral veins were compared between groups. The primary endpoint was the development of overt hepatic encephalopathy (HE) within one year after TIPS.
183 patients were eligible and classified by the presence (n = 69, 37.7 %) or absence (n = 114, 62.3 %) of HVVC. The agreement between wedged hepatic venous pressure and portal venous pressure was poor in HVVC group (intraclass correlation coefficients [ICC]: 0.141, difference: 13.4 mmHg, p < 0.001), but almost perfect in non-HVVC group (ICC: 0.877, difference: 0.4 mmHg, p = 0.152). At baseline, patients with HVVC had lower Model for end-stage liver disease scores (p < 0.001), blood ammonia levels (p < 0.001), TBA concentrations in the hepatic (p = 0.011) and peripheral veins (p = 0.049) rather than in the portal veins (p = 0.516), and a higher portosystemic pressure gradient (p = 0.035), suggesting more effective intrahepatic perfusion in this group. Within 1-year post-TIPS, HVVC group had a lower incidence of overt HE (11.7 % vs. 30.5 %, p = 0.004, HR: 0.34, 95 % CI: 0.16-0.74, absolute risk difference [ARD]: -17.4) and an improved liver transplantation-free survival rate (97.1 % vs. 86.8 %, p = 0.021, HR: 0.16, 95 % CI: 0.05-0.91, ARD: -10.3).
For patients with sinusoidal PHT treated by TIPS, the presence of HVVC was associated with a reduced risk of overt HE and a potential survival benefit.
在超过三分之一的肝硬化患者中可以检测到肝静脉-门静脉交通（HVVC），而门静脉高压（PHT）往往更为严重。我们旨在探讨 HVVC 在接受经颈静脉肝内门体分流术（TIPS）治疗的窦状 PHT 患者中的预后意义。
回顾性分析了 2020-2022 年期间接受 TIPS 期间球囊阻塞性肝静脉造影的患者的多中心数据。比较了 HVVC 组和非 HVVC 组患者在 TIPS 前门静脉、肝静脉和外周静脉中的总胆汁酸（TBA）水平。主要终点是 TIPS 后一年内显性肝性脑病（HE）的发生。
183 名患者符合条件，并根据 HVVC 的存在（n=69，37.7%）或不存在（n=114，62.3%）进行分类。HVVC 组楔入肝静脉压与门静脉压之间的一致性较差（组内相关系数[ICC]：0.141，差异：13.4mmHg，p<0.001），而非 HVVC 组几乎完美（ICC：0.877，差异：0.4mmHg，p=0.152）。基线时，HVVC 组患者的终末期肝病评分（p<0.001）、血氨水平（p<0.001）、肝静脉（p=0.011）和外周静脉（p=0.049）中的 TBA 浓度较低，而门静脉（p=0.516）中则较低，并且门体压力梯度较高（p=0.035），表明该组肝内灌注更有效。在 TIPS 后 1 年内，HVVC 组显性 HE 的发生率较低（11.7% vs. 30.5%，p=0.004，HR：0.34，95%CI：0.16-0.74，绝对风险差异[ARD]：-17.4），并且无肝移植生存率提高（97.1% vs. 86.8%，p=0.021，HR：0.16，95%CI：0.05-0.91，ARD：-10.3）。
对于接受 TIPS 治疗的窦状 PHT 患者，HVVC 的存在与显性 HE 风险降低和潜在生存获益相关。
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