The role of pre-emptive Transjugular Intrahepatic Portosystemic Shunt in acute variceal bleeding: a literature review

Manning, Charelle; Elzubeir, Amera; Alam, Syed M.

doi:10.1177/2040622321995771

Cited by 10 publications

(4 citation statements)

References 40 publications

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“…However, there is an estimated 15-21% risk of treatment failure or rebleeding in these patients, causing a rate of mortality as high as 80% [25]. In this perspective, TIPS placement in high-risk variceal bleeding patients (pre-emptive TIPS) has been clearly demonstrated to be superior to the standard medical treatment in improving survival [26][27][28][29]. A recent individual patient meta-analysis showed that preemptive TIPS significantly increased the proportion of high-risk patients with cirrhosis and acute variceal bleeding who survived for 1 year, compared with drugs plus endoscopy (hazard ratio (HR) 0.443; 95% CI 0.323-0.607; p < 0.001) [30].…”

Section: Tips Toward Liver Transplant: Role and Timingmentioning

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: Tips Toward Liver Transplant: Role and Timingmentioning

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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“…Patients with Child-Pugh class C (<14 points) or Child-Pugh class B (>7 points) with active bleeding or HVPG >20 mmHg during variceal bleed have a high risk of rebleeding and should be considered for the placement of pTIPS in 24-72 h. 10 pTIPS does not increase the risk of hepatic encephalopathy or worsening of ascites. 45 ACLF, HE, and hyperbilirubinemia at admission should not be considered as a contraindication for pTIPS as per the recent guidelines 10 (Figure 2).…”

Section: Variceal Hemorrhagementioning

confidence: 99%

Management of Portal Hypertension

Kulkarni¹,

Rabiee

Mohanty

2022

Journal of Clinical and Experimental Hepatology

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“…For this reason, an accurate cardiac assessment becomes crucial in their evaluation before TIPS placement [34]. The correct evaluation of the right heart-pulmonary circulation unit could also be useful for the assessment of patient candidates for pre-emptive TIPS, where risk stratification appears to have a major impact on outcome [35].…”

Section: Current Guidelines For Tips Implantationmentioning

confidence: 99%

Hemodynamic Evaluation of the Right Heart-Pulmonary Circulation Unit in Patients Candidate to Transjugular Intrahepatic Portosystemic Shunt

Manguso

Vignone

Merli

et al. 2022

JCM

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In Europe, liver cirrhosis represents the fourth-most common cause of death, being responsible for 170,000 deaths and 5500 liver transplantations per year. The main driver of its decompensation is portal hypertension, whose progression radically changes the prognosis of affected patients. Transjugular intrahepatic portosystemic shunt (TIPS) is one of the main therapeutic strategies for these patients as it reverts portal hypertension, thus improving survival. However, the coexistence of portal hypertension and pulmonary hypertension or heart failure is considered a contraindication to TIPS. Nevertheless, in the latest guidelines, the definition of heart failure has not been specified. It is unclear whether the contraindication concerns the presence of clinical signs and symptoms of heart failure or hemodynamic changes in the right heart-pulmonary circulation. Moreover, data about induced right heart volume overload after TIPS and the potential development of heart failure and pulmonary hypertension is currently scanty and controversial. In this article we revise this issue in finding predictors of cardiac performance after TIPS procedure. Performing a fluid challenge during right heart catheterization might be a promising expedient to test the adaptation of the right ventricle to a sudden increase in preload in the first few months after TIPS. This test may unmask a potential cardiac inability to sustain the hemodynamic load after TIPS, allowing for a clearer definition of heart failure and, consequently, a more robust indication to TIPS.

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The role of pre-emptive Transjugular Intrahepatic Portosystemic Shunt in acute variceal bleeding: a literature review

Cited by 10 publications

References 40 publications

Role of Transjugular Intrahepatic Portosystemic Shunt in the Liver Transplant Setting

Role of Transjugular Intrahepatic Portosystemic Shunt in the Liver Transplant Setting

Management of Portal Hypertension

Hemodynamic Evaluation of the Right Heart-Pulmonary Circulation Unit in Patients Candidate to Transjugular Intrahepatic Portosystemic Shunt

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