Clinical characteristics of patients with liver cirrhosis and spontaneous portosystemic shunts detected by ultrasound in a tertiary care and transplantation centre

Lipinski, Michael J.; Saborowski, Michael; Heidrich, B.; Attia, Dina; Kasten, Philipp; Manns, Michael P.; Gebel, M.; Potthoff, Andrej

doi:10.1080/00365521.2018.1498913

Cited by 19 publications

(27 citation statements)

References 24 publications

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“…To our knowledge, this is the biggest study that clinically correlates the presence of SPSSs prior to LT to outcomes in the post‐LT setting. Our results suggest that after LT surgery, the previously described clinical impact of SPSSs in the population with cirrhosis subsides …”

Section: Discussionsupporting

confidence: 56%

“…Similarly, large SPSSs have been found to correlate with more advanced liver disease, as determined by a higher Child‐Turcotte‐Pugh score or an increased Model for End‐Stage Liver Disease (MELD‐Na) score. In patients with stable liver function, the presence of SPSSs was associated with lower transplant‐free survival . These results can therefore allow us to risk stratify patients in the pretransplantation period on the basis of the presence and size of SPSSs.…”

mentioning

confidence: 87%

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Clinical Outcomes of Portosystemic Shunts on the Outcome of Liver Transplantation

et al. 2020

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Spontaneous portosystemic shunts (SPSSs) have been associated with worse clinical outcomes in the pre-liver transplantation (LT) setting, but little is known about their post-LT impacts. Our aim was to compare LT candidates with and withoutSPSSs and assess the impact of SPSSs on patient mortality and graft survival in the post-LT setting. Patients 18 years or older with abdominal imaging done prior to LT were included. Exclusion criteria were the presence of pre-LT surgical shunts, LT indications other than cirrhosis, and combined solid organ transplantations. SPSSs were classified as absent, small, or large according to their maximum diameter (8 mm). Multiple variables that could influence the post-LT course were extracted for analysis. Patient and graft survival were estimated using the Kaplan-Meier method and were compared between groups using a log-rank test. The project received institutional review board approval. We extracted data from 326 patients. After comparing patients without SPSS or with small or large SPSSs, no statistical difference was found for overall patient survival: no SPSS (n = 8/63), reference; small SPSS (n = 18/150), hazard ratio (HR), 1.05 (95% confidence interval [CI], 0.45-2.46); and large SPSS (n = 6/113), HR, 0.60 (95% CI, 0.20-1.78); P = 0.20. Also, no difference was found for graft survival: no SPSS (n = 11/63), reference; small SPSS (n = 21/150), HR, 0.80 (95% CI, 0.38-1.70); large SPSS (n = 11/113), HR, 0.59 (95% CI, 0.25-1.40); P = 0.48. Similarly, no statistical significance was found for these variables when comparing if the graft used was procured from a donation after circulatory death donor versus a donation after brain death donor. In conclusion, the previously described association between SPSSs and worse clinical outcomes in pre-LT patients seems not to persist once patients undergo LT. This study suggests that no steps to correct SPSS intraoperatively are necessary. Liver Transplantation 26 693-701 2020 AASLD.Portal hypertension is defined by a hepatic venous pressure gradient of 6 mmHg or more, and in the clinical scenario of cirrhosis, it is characterized by complications, such as ascites, variceal bleeding, and hepatic encephalopathy in advanced cases. (1) In cirrhosis, portal hypertension results from the increased collagen deposition and formation of regenerative nodules, which eventually lead to an increase in portal pressure. (2) These changes are followed by compensatory splanchnic vasodilation, which will further increase portal flow and continue to worsen portal pressure (as predicted by Ohm's law). The presence of these complications leads to clinical deterioration, with some series describing up to 80% 5-year mortality if 2 complications were present concomitantly, (3) which also results in cost increases due to frequent hospital admissions. (4) A complication in the setting of portal hypertension is the formation of spontaneous portosystemic shunts (SPSSs). These are channels that form as the portal rOdriguez et al.

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Section: Discussionsupporting

confidence: 56%

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confidence: 87%

Clinical Outcomes of Portosystemic Shunts on the Outcome of Liver Transplantation

et al. 2020

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“…27,31 Rodriguez et al provided recent data from a cohort of 326 patients with cirrhosis and candidates for LT in which a high rate of SPSS was found (almost 80%), with a slight predominance of small SPSSs (46% from the total) over large SPSSs (35%). 33 Many studies have evaluated the type of shunt detected, 25,[27][28][29]32,35,43 and most of them have focused on the identification of a specific type of SPSS (Table 1). 30,31,[36][37][38][39][40][41][42]44,46 Paraumbilical vein shunt was the most frequently reported SPSS, found in up to 43% of patients 30,31,[35][36][37][38]47 and even 59% when combined with other SPSSs.…”

Section: Spss Prevalence In Liver Cirrhosismentioning

confidence: 99%

“…57,63 This hypothesis is reinforced by the fact that patients with SPSSs showed worse liver function in many studies (assessed both Child-Pugh class and MELD score). 25,[27][28][29][36][37][38]42 In the largest published cohort previously mentioned, patients with large SPSSs had higher Child-Pugh and MELD score than those with small collaterals, and both had worse liver function than patients without shunts. 25…”

Section: Pathophysiologymentioning

confidence: 99%

“… 25 , 26 With these limitations, the largest series available performed by ultrasound estimate the global percentage of SPSSs between 34% and 42%. 27 – 31 There are fewer studies carried out with enhanced CT or MR imaging with data about general prevalence ( Table 1 ). 25 , 32 , 33 Aucejo et al identified 12% of SPSSs in a cohort of 127 patients with cirrhosis evaluated for LT. 32 A more recent study, conducted by the Baveno VI Cooperation Group, consisted of an international multicenter collaboration that evaluated 1729 patients with liver cirrhosis.…”

Section: Spss Prevalence In Liver Cirrhosismentioning

confidence: 99%

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Spontaneous portosystemic shunts in liver cirrhosis: new approaches to an old problem

Vidal‐González

Quiroga

Simón-Talero

et al. 2020

Therap Adv Gastroenterol

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Portal hypertension is the main consequence of liver cirrhosis, leading to severe complications such as variceal hemorrhage, ascites or hepatic encephalopathy. As an attempt to decompress the portal venous system, portal flow is derived into the systemic venous system through spontaneous portosystemic shunts (SPSSs), bypassing the liver. In this review, we aim to provide an overview of the published reports in relation to the prevalence and physiopathology behind the appearance of SPSS in liver cirrhosis, as well as the complications derived from its formation and its management. The role of SPSS embolization is specifically discussed, as SPSSs have been assessed as a therapeutic target, mainly for patients with recurrent/persistent hepatic encephalopathy and preserved liver function. Furthermore, different aspects of the role of SPSS in liver transplantation, as well as in candidates for transjugular intrahepatic portosystemic shunt are reviewed. In these settings, SPSS occlusion has been proposed to minimize possible deleterious effects, but results are so far inconclusive.

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Ultrasonography in the diagnosis of complications in patients with portal hypertension

Hidaka

Uojima

2021

J Med Ultrasonics

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This review focuses on ultrasonography (US) to diagnose patients with complications in portal hypertension. Clinicians first use US to evaluate patients with suspected portal hypertension, because US is quick, simple, and radiation free. US is necessary for grading and performing paracentesis for ascites. Doppler US-based detection of reverse splanchnic vein flow or the presence of a spontaneous portosystemic shunt is highly specific in patients with cirrhosis. Since it is important to estimate spleen size in patients with portal hypertension, spleen size is usually measured by US. Spleen volume can be more accurately measured with 3D-US. Estimation of viable residual splenic volume after partial splenic embolization should be limited to cases with total splenic volume less than 1000 ml. Portal vein thrombosis is often detected during the US examination performed when symptoms first appear or during the follow-up. Two-dimensional transthoracic echocardiography is an excellent noninvasive screening test in patients with pulmonary portal hypertension who can undergo it. By measuring the maximum and minimum diastolic blood flow velocities in the renal arteries using renal color Doppler US, the pulsatility index (PI) and resistive index (RI) can be calculated. The PI and RI in cirrhotic patients were significantly higher than those in healthy subjects and patients with chronic hepatitis, and showed a significant positive correlation with the Child-Pugh Score. In conclusion, US is an essential tool for the diagnosis and treatment of patients with portal hypertension.

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Clinical characteristics of patients with liver cirrhosis and spontaneous portosystemic shunts detected by ultrasound in a tertiary care and transplantation centre

Cited by 19 publications

References 24 publications

Clinical Outcomes of Portosystemic Shunts on the Outcome of Liver Transplantation

Clinical Outcomes of Portosystemic Shunts on the Outcome of Liver Transplantation

Spontaneous portosystemic shunts in liver cirrhosis: new approaches to an old problem

Ultrasonography in the diagnosis of complications in patients with portal hypertension

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