Safety and efficacy of transarterial chemoembolization in patients with transjugular intrahepatic portosystemic shunts

Miura, John T.; Rilling, William S.; White, Sarah B.; Hieb, Robert A.; Tutton, Sean; Patel, Parag J.; Gamblin, T. Clark; Hohenwalter, Eric J.

doi:10.1111/hpb.12433

Cited by 15 publications

(12 citation statements)

References 18 publications

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“…TACE takes the advantage of the hepatic dual blood supply resulting in emboli-zation of the tumor-feeding hepatic arteries, while portal venous flow to normal hepatocytes is preserved[15]. TACE in TIPS patients may be associated with increased hepatotoxicity[16]. This important change in the blood supply may aggravate hepatic necrosis[17], and when arteries that supply HCC are embolized, many factors can compensate for liver failure[18].…”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of transjugular intrahepatic portosystemic shunt combined with palliative treatment in patients with hepatocellular carcinoma

Luo¹,

Chu²,

Huang³

et al. 2019

WJCC

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BACKGROUND There is a close relationship between cirrhosis and hepatocellular carcinoma (HCC). Transjugular intrahepatic portosystemic shunt (TIPS) has good clinical effect in treating the complication of portal hypertension. However, because of the risk of postoperative liver failure, severe complications, and low survival rate for HCC, TIPS is contraindicated in patients with portal hypertension and liver cancer. We studied a large cohort of patients with cirrhosis and HCC who underwent TIPS for recurrent variceal bleeding and/or ascites. AIM To assess the safety, efficacy, and survival rate in patients with HCC who underwent TIPS. METHODS Group A comprised 217 patients with HCC and portal hypertension who underwent the TIPS procedure between 1999 and 2014. After TIPS deployment, these patients received palliative treatment for HCC. Group B comprised a cohort of 136 HCC patients with portal hypertension who did not undergo TIPS placement. Group B received palliative treatment for HCC plus medical therapy for portal hypertension. The clinical outcomes and survival rate were assessed. RESULTS In Group A, the primary technical success rate was 97.69% for TIPS placement, and no severe procedure-related complications of TIPS placement were reported. The control of variceal bleeding (VB) within 1 mo did not differ significantly between the groups ( P = 0.261). Absorption of refractory ascites within 1 mo, recurrence of VB, and recurrence of refractory ascites differed significantly between the groups ( P = 0.017, 0.023, and 0.009, respectively). By comparison, the rate of hepatic encephalopathy in Group B was lower than that in Group A ( P = 0.036). The 1-, 2-, 3-, 4-, and 5-year survival rates were significantly different between Groups A and B (χ 2 = 12.227, P = 0.018; χ 2 = 12.457, P = 0.014; χ 2 = 26.490, P = 0.013; χ 2 = 21.956, P = 0.009, and χ 2 = 24.596, P = 0.006, respectively). The mean survival time was 43.7 mo in Group A and 31.8 mo in Group B. Median survival time was 50.0 mo in Group A and 33.0 mo in Group B. Mean and median survival differed significantly between the two groups ( P = 0.000, χ 2 = 35.605, log-rank test). The mortality rate from VB in Group A was low than that in Group B ( P = 0.006), but the rates of hepatic tumor, hepatic failure, and multiorgan failure did not differ significantly between the two groups ( P = 0.173, 0.246 and 0.257, respectively). CONCLUSION TIPS combined with palliative treatment is saf...

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Section: Discussionmentioning

confidence: 99%

Safety and efficacy of transjugular intrahepatic portosystemic shunt combined with palliative treatment in patients with hepatocellular carcinoma

Luo¹,

Chu²,

Huang³

et al. 2019

WJCC

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“…TACE has emerged as an effective treatment strategy for patients with HCC. Although TACE was an effective treatment strategy for HCC with TIPSS, Miura et al [ 18 ] proved that TACE might be associated with higher complication rates for patients who are treated with TIPSS. Thus, we excluded the patients treated with TACE.…”

Section: Discussionmentioning

confidence: 99%

Short outcome comparison of elderly patients versus nonelderly patients treated with transjugular intrahepatic portosystemic stent shunt

et al. 2017

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A transjugular intrahepatic portosystemic stent shunt (TIPSS) has been widely used to treat portal hypertension and its complications. However, no established guidelines mentioned whether age was a risk factor for the treatment of TIPSS.The aim is to determine whether age is a risk factor for poor outcomes following TIPSS.The retrospective cohort study included 134 patients who received TIPSS treatment from 2003 to 2016. The adverse events after the TIPSS treatment were compared after propensity score matching to reduce the effect of selection bias. Multivariate logistic regression was conducted to confirm the potential confounders for rebleeding (RB) and ascites after TIPSS therapy.After excluding 10 patients, 124 patients were analyzed. Among them, 37 patients were included in the elderly group. In the propensity score matched cohort (32 pairs), there was no significant difference between the elderly group and the nonelderly group in terms of the event after TIPSS therapy (All P > .05). Multivariate logistic regression analysis revealed that hypertension (OR 13.246, 95% CI: [1.29, 136.073]; P = .03) was an independent risk factor for RB. In addition, smoking (OR 4.48, 95% CI: [1.43, 14.033]; P = .01) and preascites (OR 6.7, 95% CI: [2.04, 22.005]; P = .002) were independent risk factors for ascites after TIPSS treatment.Age is not an independent risk factor for poor outcomes following the treatment of TIPSS. Smoking and preascites are independent risk factors for patients’ ascites, and hypertension is an independent risk factor for patients’ RB after TIPSS therapy.

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“…13 Another retrospective cohort study of 16 patients with TIPS who underwent conventional TACE procedures reported grade 3 or 4 hepatobiliary SAEs in 25% of patients. 14 Kohi et al retrospectively compared the incidence of hepatotoxicity within 30 days of conventional TACE for HCC between 10 patients with TIPS and 148 controls. BCLC stage was 0/A in 60% of patients in the TIPS group and 63% of the control group; however, a high proportion of patients in both groups had baseline Child-Pugh class B or C liver function (50% in the TIPS group, 72% in the control group).…”

Section: Discussionmentioning

confidence: 99%

Liver Infarction after Drug-Eluting Embolic Transarterial Chemoembolization for Hepatocellular Carcinoma in the Setting of a Large Portosystemic Shunt

Park

Gaba

Lokken

2016

Semin intervent Radiol

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Safety and efficacy of transarterial chemoembolization in patients with transjugular intrahepatic portosystemic shunts

Abstract: TACE is an effective treatment strategy for HCC in TIPS patients; albeit may be associated with higher complication rates.

Cited by 15 publications

References 18 publications

Safety and efficacy of transjugular intrahepatic portosystemic shunt combined with palliative treatment in patients with hepatocellular carcinoma

Safety and efficacy of transjugular intrahepatic portosystemic shunt combined with palliative treatment in patients with hepatocellular carcinoma

Short outcome comparison of elderly patients versus nonelderly patients treated with transjugular intrahepatic portosystemic stent shunt

Liver Infarction after Drug-Eluting Embolic Transarterial Chemoembolization for Hepatocellular Carcinoma in the Setting of a Large Portosystemic Shunt

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