Document Type

Conference Proceeding

Publication Date

10-2023

Publication Title

Hepatology

Abstract

Background: Patients with hepatocellular carcinoma (HCC) and cirrhosis can present with features of severe portal hypertension, which can be worsened further with associated portal vein tumoral thrombosis (PVTT). Due to the technical difficulties and short survival of these patients, HCC was traditionally considered a relative contraindication for transjugular intrahepatic portosystemic shunt (TIPS). However, there is an increasing body of evidence supporting the use of TIPS in HCC. The present study aimed to analyze the efficacy and safety of TIPS in patients with HCC. Methods: A literature search of MEDLINE, Embase, and Scopus was conducted from 2000 to October 2022 for studies analyzing the outcome of TIPS in HCC. The primary outcomes were technical and clinical success, adverse events (AE), and mortality. The event rates were pooled using a random effects model. Results: A total of 19 studies with 1498 patients were included in the final analysis. The pooled technical and clinical success rates with TIPS in HCC were 98.8% (98.0 – 99.7) and 94.1% (91.2 – 97.0), respectively. The mean reduction in hepatic venous pressure gradient from baseline varied from 10 to 20.2 mm Hg, with a pooled mean difference of 13.65 mm Hg (95% CI: 12.05 – 15.24). After TIPS, ascites was controlled in 89.2% (85.1 – 93.3) of the cases, while rebleeding was observed in 17.2% (9.4 – 25.0) of cases on follow-up. The pooled incidence of overall AE, serious AE, and post-TIPS hepatic encephalopathy was 5.2% (2.5 – 7.9), 0.1% (0.0 – 0.4), and 25.1% (18.7 – 31.5), respectively. The reported serious AEs included: acute liver failure, tumor rupture causing intraabdominal bleeding, and post-TIPS intraabdominal bleeding. On follow-up, 11.9% (7.8 – 15.9) of the patients developed shunt dysfunction requiring reintervention. The pooled 1-year mortality rate with TIPS in HCC was 34.2% (95% CI: 18.9 – 49.5), with mortality being significantly higher in those undergoing TIPS for portal vein tumoral thrombosis (64.5%, 95% CI: 34.9 – 94.2) than those without (22.7%, 95% CI: 13.1 – 32.3) (p =0.009). Table 1 summarizes the findings of the present analysis with subgroup analysis. Conclusion: The present analysis supports the feasibility, safety, and efficacy of TIPS in the management of portal hypertension in patients with HCC.

Volume

78

Issue

S1

First Page

S1836

Comments

American Association for the Study of Liver Diseases AASLD, The Liver Meeting, November 10-14, 2023, Boston, MA.

DOI

10.1097/HEP.0000000000000580

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