Safety and effectiveness of transjugular intrahepatic portosystemic shunt in hepatocellular carcinoma patients with portal hypertension: a systematic review and meta-analysis

Chen, Z.-X.; Qiu, Zhenkang; Wang, G.-B.; Wang, G.-S.; Jiang, Weiwei; Gao, Fan

doi:10.1016/j.crad.2022.09.126

Cited by 3 publications

(2 citation statements)

References 30 publications

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“…The major safety issues are related to the size of the tumor, the possibility that the nodule location interferes with the trajectory of the stent, and the eventual risk of distant metastasis caused by the procedure [75]. Definite answers about these issues are lacking and, in the majority of cases, the decision will need a team discussion between the radiologist, the hepatologist, and the surgeon.…”

Section: Hepatocellular Carcinoma (Hcc)mentioning

confidence: 99%

Role of Transjugular Intrahepatic Portosystemic Shunt in the Liver Transplant Setting

Di Cola,

Lapenna,

Gazda

et al. 2024

JCM

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Liver transplantation is currently the only curative therapy for patients with liver cirrhosis. Not all patients in the natural course of the disease will undergo transplantation, but the majority of them will experience portal hypertension and its complications. In addition to medical and endoscopic therapy, a key role in managing these complications is played by the placement of a transjugular intrahepatic portosystemic shunt (TIPS). Some indications for TIPS placement are well-established, and they are expanding and broadening over time. This review aims to describe the role of TIPS in managing patients with liver cirrhosis, in light of liver transplantation. As far as it is known, TIPS placement seems not to affect the surgical aspects of liver transplantation, in terms of intraoperative bleeding rates, postoperative complications, or length of stay in the Intensive Care Unit. However, the placement of a TIPS “towards transplant” can offer advantages in terms of ameliorating a patient’s clinical condition at the time of transplantation and improving patient survival. Additionally, the TIPS procedure can help preserve the technical feasibility of the transplant itself. In this context, indications for TIPS placement at an earlier stage are drawing particular attention. However, TIPS insertion in decompensated patients can also lead to serious adverse events. For these reasons, further studies are needed to make reliable recommendations for TIPS in the pre-transplant setting.

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Section: Hepatocellular Carcinoma (Hcc)mentioning

confidence: 99%

Role of Transjugular Intrahepatic Portosystemic Shunt in the Liver Transplant Setting

Di Cola,

Lapenna,

Gazda

et al. 2024

JCM

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“…In particular, stent dysfunction and hepatic encephalopathy (HE) are recognized as common major complications of TIPS. In a recent meta-analysis, TIPS dysfunction was defined as the need for reintervention or clinical relapse, and its pooled incidence was 23% [ 18 ]. A possible cause of the increasing incidence of shunt dysfunction might be related to bare stent placement; there is significantly lower incidence in patients with polytetrafluoroethylene (PTFE)-coated stents.…”

Section: Technical Feasibility and Safety Of Tips Use In Hcc Patientsmentioning

confidence: 99%

The Role of Transjugular Intrahepatic Portosystemic Shunt (TIPS) in Treating Portal Hypertension in Patients with Hepatocellular Carcinoma

et al. 2023

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Liver cancer is very frequent, and hepatocellular carcinoma (HCC) accounts for the majority of liver cancer cases. Its growing incidence has been greatly affected by the increasing prevalence of metabolic-associated fatty liver disease (MAFLD). The latter is a new epidemic in our era. In fact, HCC is often generated from noncirrhotic liver and its treatment benefits from surgical and nonsurgical approaches, potentially bridged by transjugular intrahepatic portosystemic shunt (TIPS) use. TIPS use is an effective treatment for portal hypertension complications, but its application in patients with HCC and clinically significant portal hypertension (CSPH) remains controversial due to concerns about tumor rupture, dissemination, and increased toxicity. The technical feasibility and safety of TIPS use in HCC patients have been evaluated in several studies. Despite concerns about intraprocedural complications, retrospective studies have shown high success rates and low complication rates in TIPS placement for HCC patients. TIPS use in combination with locoregional treatments, such as transarterial chemoembolization (TACE) or transarterial radioembolization (TARE), has been explored as a treatment option for HCC patients with portal hypertension. These studies have shown improved survival rates in patients undergoing TIPS in combination with locoregional treatments. However, the efficacy and toxicity of TACE in combination with TIPS use require careful evaluation, as changes in venous and arterial flow can affect treatment outcomes and complications. The results from studies evaluating the impact of TIPS on systemic therapy and surgical options are also promising. In conclusion, the TIPS is a sufficiently safe, useful item available for physicians treating complications of portal hypertension. Moreover, a TIPS can be used in combination with locoregional therapy in HCC patients. Systemic chemotherapy can also benefit of the use of TIPS placement. A complex interplay affects TIPS use with surgery. The latter needs further data. The TIPS is a useful and safe add-on treatment, changing the natural course of HCC progression. Its use is regulated by a sophisticated physiologic and pathophysiologic flow of evidence.

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Role of Transjugular Intrahepatic Portosystemic Shunt in the Liver Transplant Setting

Di Cola,

Lapenna,

Gazda

et al. 2023

Preprint

View full text Add to dashboard Cite

Liver transplantation is currently the only curative therapy for patients with liver cirrhosis. Not all patients in the natural course of the disease will undergo transplantation, but the majority of them will experience portal hypertension and its complications. In addition to medical and endoscopic therapy, a key role in managing these complications is played by the placement of a transjugular intrahepatic portosystemic shunt (TIPS). Some indications for TIPS placement are well-established and they are expanding and broadening over time. This review aims to describe the role of TIPS in managing patients with liver cirrhosis, considering them as potential candidates for liver transplantation. As far as is known TIPS placement seems not to affect the surgical aspects of liver transplantation, in terms of intra operative bleeding rates, postoperative complications or length of stay in the Intensive Care Unit. However, the placement of a TIPS “towards transplant" can offer advantages in terms of enhancing the patient's clinical condition at the time of transplantation and improving patient survival. Additionally, the TIPS procedure can help preserve the technical feasibility of the transplant itself. In this context, indications for TIPS placement may be expanded and considered at an earlier stage. TIPS insertion can also lead to serious adverse events and there are no evidence-based recommendations on this topic to date. For these reasons further studies are needed to make reliable recommendations for TIPS in the pre-transplant setting.

show abstract

Safety and effectiveness of transjugular intrahepatic portosystemic shunt in hepatocellular carcinoma patients with portal hypertension: a systematic review and meta-analysis

Cited by 3 publications

References 30 publications

Role of Transjugular Intrahepatic Portosystemic Shunt in the Liver Transplant Setting

Role of Transjugular Intrahepatic Portosystemic Shunt in the Liver Transplant Setting

The Role of Transjugular Intrahepatic Portosystemic Shunt (TIPS) in Treating Portal Hypertension in Patients with Hepatocellular Carcinoma

Role of Transjugular Intrahepatic Portosystemic Shunt in the Liver Transplant Setting

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