Transjugular Intrahepatic Portosystemic Shunt (TIPS): A Bridge to Bariatric Surgery in Morbidly Obese Patients with Cirrhosis and Clinically Significant Portal Hypertension

期刊论文
发表日期：

2024年12月29日

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Raluca Pais,
Yasmina Chouik,
Lucile Moga,
Louise Lebedel,
Christine Silvain,
Laurent Genser,
Delphine Weill,
Hélène Larrue,
Emilie Malézieux,
Caroline Jezéquel,
Maud Robert,
Hélène Regnault,
Jérôme Dumortier,
Vlad Ratziu,
Dominique Thabut,
Marika Rudler

摘要

Background

In cirrhotic patients, portal hypertension increases mortality after surgery. We evaluated the impact of pre-operative transjugular intrahepatic portosystemic shunt (TIPS) on the outcomes of bariatric surgery in cirrhosis.

Methods

Multicentric retrospective cohort. The decision for TIPS placement has been made according to hepatic venous pressure gradient (HVPG) values and centers’ policy. The primary outcome: 1-year decompensation-free survival; secondary outcomes: 1-year acute-on-chronic liver failure (ACLF) and survival.

Results

Fifty-three patients were included (2010–2022): 92% Child–Pugh A, MELD score 8, age 55 years, BMI 38.3 ± 13 kg/m², 9 (18%) had TIPS. At baseline, patients with TIPS had more esophageal varices (89% vs 10%, p < 0.001), more previous decompensations (22% vs 0%, p = 0.002), and a higher HVPG (14 vs 7 mmHg, p < 0.001). All patients in the TIPS group had clinically significant portal hypertension vs 11% of patients without TIPS, p < 0.001. One-year decompensation-free survival was 77.8% and 93.2% in patients with and without TIPS, p = 0.064. ALCF occurred in 3 patients (6.8%) without TIPS and none with TIPS. All patients were alive 1 year after surgery.

Conclusions

In patients with cirrhosis and clinically significant portal hypertension (CSPH) undergoing bariatric surgery, TIPS placement was safe and had similar outcomes after surgery as patients without TIPS.