Effect of liver volume in morbidity and mortality after elective transjugular intrahepatic portosystemic shunt

Lopera, Jorge E.; Speeg, Kermit V; Young, Carmen; Garg, Deepak; Michalek, Joel E.; Chen, Yumin; Kroma, G.; Suri, Rajeev; Garza-Berlanga, A.

doi:10.1016/j.gii.2014.10.003

Cited by 4 publications

(14 citation statements)

References 21 publications

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“…Various models have been developed to predict survival after TIPS, while the MELD-score is one of the most commonly used in clinical routine [ 5 , 6 , 16 , 17 , 18 , 19 ]. Careful patient selection proceeding for TIPS continues to be a clinical challenge as some patients may develop post-TIPS liver failure despite initially preserved liver function as determined by laboratory data [ 6 ]. TIPS insertion alters the intrahepatic hemodynamics while the reduced portal blood supply may affect the reserve volume and function of the liver [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

“…In contrast, creating a portosystemic shunt alters the intrahepatic hemodynamics and results in decreased liver perfusion with possible impairment of liver function and progression to liver failure [ 5 ]. In cirrhotic patients, loss of liver volume leads to deterioration of liver function and is a poor prognostic factor in cirrhosis [ 6 , 7 ]. However, liver volume has not yet been extensively studied as a potential variable being suitable for patient selection for TIPS [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

“…In cirrhotic patients, loss of liver volume leads to deterioration of liver function and is a poor prognostic factor in cirrhosis [ 6 , 7 ]. However, liver volume has not yet been extensively studied as a potential variable being suitable for patient selection for TIPS [ 6 ]. Despite a thorough patient evaluation proceeding for TIPS, including assessment of the Model of End-Stage Liver Disease (MELD), Freiburg index of post-TIPS survival (FIPS), Child–Pugh score and hepatic encephalopathy, there are still challenges regarding the appropriate workup for TIPS patients [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

“…Despite a thorough patient evaluation proceeding for TIPS, including assessment of the Model of End-Stage Liver Disease (MELD), Freiburg index of post-TIPS survival (FIPS), Child–Pugh score and hepatic encephalopathy, there are still challenges regarding the appropriate workup for TIPS patients [ 8 ]. The assessment of the liver volume using pre-procedural imaging may have a predictive value for post-TIPS liver function and outcome and hence might be a simple tool in patient selection to optimize the balance of detriments and benefits achieved by TIPS [ 6 , 9 , 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

“…It is useful in the pre-operative planning of major resection or living donor liver transplantation where the technical and clinical success depend on the future remnant liver volume or liver graft size in transplantation [ 12 , 13 , 14 ]. However, there are only limited data regarding the imaging-based assessment of liver volume in the patient selection for TIPS and follow-up of TIPS patients [ 6 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Lower Ratio of Liver Volume and Body Weight Is a Negative Predictor of Survival after Transjugular Intrahepatic Portosystemic Shunt

Schindler

Riegel

Görlich

et al. 2021

JPM

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Transjugular intrahepatic portosystemic shunt (TIPS) is the most effective measure to treat complications of portal hypertension. However, liver function may deteriorate after TIPS. Predictors of liver function and outcome after TIPS are therefore important for management of TIPS patients. The study aimed to evaluate the impact of liver volume on transplant-free survival (TFS) after TIPS, as well as the evolution of liver volume and its relationship with liver function after TIPS. A retrospective analysis of all consecutive patients who underwent TIPS in a tertiary care university liver center between 2012 and 2017 (n = 216) was performed; n = 72 patients with complete prior and follow-up (FU) computed tomography (CT) imaging studies were included in the study. Volumetry of the liver was performed by a semi-automatic 9-lobe image segmentation algorithm at baseline and FU (FU 1: 90–180 d; FU 2: 180–365 d; FU 3: 365–545 d; FU 4: 545–730 d; FU 5: >730 d). Output variables were total liver volume (TLV, cm3), left liver volume (LLV, cm3), right liver volume (RLV, cm3) and TLV/body weight ratio. CT derived liver volumes were correlated with liver function tests, portosystemic pressure gradient (PPG) measurements and survival. To assess predictors of liver volume change over time we fitted linear mixed models. Kaplan–Meier analysis was performed and validated by matched pair analysis followed by Cox regression to determine independent prognostic factors for survival. The median TLV at baseline was 1507.5 cm3 (773.7–3686.0 cm3). Livers with higher baseline liver volumes and larger TLV/weight ratios retained their volume after an initial loss while smaller livers continuously lost volume after TIPS. At the first follow-up period (90–180 d post-TIPS) lower liver volumes and TLV/weight ratios were associated with higher bilirubin levels. Within the final multivariable model containing time (days since TIPS), baseline INR and baseline TLV, the average loss of liver volume was 0.74 mL per day after TIPS. Twelve-month overall transplant-free survival was 89% and median overall TFS was 33 months. The median TFS for a baseline TLV/body weight ratio > 20 was significantly higher compared with ≤ 20 (40.0 vs. 27.0 months, p = 0.010) while there were no differences regarding the indication for TIPS or etiology of liver disease in the matched pair analysis. Lower TLV/weight ratios before TIPS were associated with shorter TFS and should therefore be critically considered when selecting patients for TIPS. In addition, this study provides first evidence of an effect of TIPS on subsequent liver volume change and associated liver function.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Lower Ratio of Liver Volume and Body Weight Is a Negative Predictor of Survival after Transjugular Intrahepatic Portosystemic Shunt

Schindler

Riegel

Görlich

et al. 2021

JPM

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A Comprehensive Review of Transjugular Intrahepatic Portosystemic Shunt–Related Complications

Lopera

2023

Semin intervent Radiol

Self Cite

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Transjugular intrahepatic portosystemic shunt (TIPS) is one of the most technically complex procedures in interventional radiology, the need to connect two veins with variable anatomy, located in two different planes in hard and many times small cirrhotic livers using a needle, can be quite challenging. Despite more than 30 years of performing TIPS, the complex hemodynamics of the portal system are not fully understood, and sometimes unpredictable alterations of the portal flow can lead to serious unexpected complications. The best strategies to prevent TIPS complications are optimal patient selection, meticulous technique, operator experience, and immediate correction of identified adverse events. The purpose of this article is to review the technical complications with TIPS, the unique complications related to the use of stent grafts, and the late complications after the procedure, with emphasis on ways to prevent and treat them.

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The impact of hepatic and splenic volumetric assessment in imaging for chronic liver disease: a narrative review

Kutaiba,

Chung,

Goodwin

et al. 2024

Insights Imaging

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Chronic liver disease is responsible for significant morbidity and mortality worldwide. Abdominal computed tomography (CT) and magnetic resonance imaging (MRI) can fully visualise the liver and adjacent structures in the upper abdomen providing a reproducible assessment of the liver and biliary system and can detect features of portal hypertension. Subjective interpretation of CT and MRI in the assessment of liver parenchyma for early and advanced stages of fibrosis (pre-cirrhosis), as well as severity of portal hypertension, is limited. Quantitative and reproducible measurements of hepatic and splenic volumes have been shown to correlate with fibrosis staging, clinical outcomes, and mortality. In this review, we will explore the role of volumetric measurements in relation to diagnosis, assessment of severity and prediction of outcomes in chronic liver disease patients. We conclude that volumetric analysis of the liver and spleen can provide important information in such patients, has the potential to stratify patients’ stage of hepatic fibrosis and disease severity, and can provide critical prognostic information. Critical relevance statement This review highlights the role of volumetric measurements of the liver and spleen using CT and MRI in relation to diagnosis, assessment of severity, and prediction of outcomes in chronic liver disease patients. Key Points Volumetry of the liver and spleen using CT and MRI correlates with hepatic fibrosis stages and cirrhosis. Volumetric measurements correlate with chronic liver disease outcomes. Fully automated methods for volumetry are required for implementation into routine clinical practice. Graphical Abstract

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Effect of liver volume in morbidity and mortality after elective transjugular intrahepatic portosystemic shunt

Cited by 4 publications

References 21 publications

Lower Ratio of Liver Volume and Body Weight Is a Negative Predictor of Survival after Transjugular Intrahepatic Portosystemic Shunt

Lower Ratio of Liver Volume and Body Weight Is a Negative Predictor of Survival after Transjugular Intrahepatic Portosystemic Shunt

A Comprehensive Review of Transjugular Intrahepatic Portosystemic Shunt–Related Complications

The impact of hepatic and splenic volumetric assessment in imaging for chronic liver disease: a narrative review

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