Transjugular liver biopsy: correlation of bleeding complications to INR values in 613 consecutive patients

Abstract

Purpose: To evaluate the predictive value of portal vein pressures and porto-systemic gradients in patients prior to and following TIPS placement. Materials and Methods: Retrospective review of 100 patients that underwent TIPS at UCLA medical center between 2009 and 2013 was performed. Patients with documented pre-TIPS portal vein pressures as well as post-TIPS portal vein pressures and porto-systemic gradients were included. End points included survival to liver transplantation, one-year mortality, and need for revision. Results: Twenty-one patients that underwent TIPS went on to liver transplantation. For those patients, the mean pre-TIPS portal vein pressure (PVP) was 26.6 mmHg, pre-TIPS portosystemic gradient (PSG) 15.2, post-TIPS portal vein pressure 20.7, and post-TIPS portosystemic gradient 6.6.Twenty-seven patients that did not go onto liver transplantation were alive at one year. For those patients, the mean pre-TIPS PVP was 27.4, pre-TIPS PSG 18.1, post-TIPS PVP 21.2, and post-TIPS PSG 8.0.Twenty-one patients died within the first year. For those patients, the mean pre-TIPS PVP was 29.1, pre-TIPS PSG 18.2, post-TIPS PVP 22.1, post-TIPS PSG 7.1.Twenty-four patients required TIPS revision. For those patients, the mean pre-TIPS PVP was 29.1, pre-TIPS PSG 17.4, post-TIPS PVP 23.7, post TIPS PSG 8.2. Conclusion: Patients that were successfully bridged to transplantation with TIPS had the lowest pre-TIPS portal vein pressures, pre-TIPS portosystemic gradients, and post-TIPS portosystemic gradients. Patients that were dead at one year and requiring TIPS revision had higher pre-TIPS portal vein pressures. Thus in conclusion, portal vein pressure measurements and portosystemic gradients are helpful surrogates in predicting transplant and mortality outcomes following TIPS.