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Abstract No. 74: Effect of liver volume in morbidity and mortality after elective TIPS
MONDAY: Scientific Sessions
S34 䡲 Monday
Scientific Sessions 䡲 JVIR
Purpose: To determine what clinical, laboratory, or procedural variables predict the need for TIPS revisions in individuals with PTFE-covered TIPS. Materials and Methods: Between 2003–2009, a total of 141 patients underwent TIPS venographic evaluation following TIPS placement with PTFE-covered stents. Of these, a total of 43 patients required TIPS revisions. Twenty-three (23) different variables were modeled using univariate analysis, and then evaluated using a Cox proportional hazards model. Results: Of the variables tested, only the presence of a previous intervention predicted the need for further interventions (p⫽0.03). This variable also had an interaction with time (e.g. the hazard ratio increased over time), so that there was a greater likelihood of a need for a second revision as the time from the previous intervention increased. Other variables, including the size of the stent, etiology of portal hypertension, post-TIPS portosystemic gradient, and intrahepatic stent location failed to predict the need for future interventions. Conclusion: Individuals requiring one TIPS reinterventions should be aggressively screened for TIPS failures because of the increased likelihood that they will require another intervention. No correlation with other clinical, laboratory, or procedural variables was noted with the need for TIPS revisions.
8:36 AM
Abstract No. 74
Effect of liver volume in morbidity and mortality after elective TIPS J. Lopera1, K. Speeg2, D. Garg1, R. Suri1, G. Kroma1, F. Rivera1, W. Castaneda1; 1Radiology, UT Health Science Center, San Antonio, TX; 2Hepatology, UT Health Science Center, San Antonio, TX Purpose: To study the effect of liver volume (LV) in the morbidity and mortality after elective TIPS. Materials and Methods: A retrospective review was performed in patients admitted for elective TIPS in a single tertiary transplant center between 2003 and 2009. LV was measured in CT or MRI scans performed 1–3 months before the procedure. A possible correlation between LV and major adverse events (Hepatic Encephalopathy requiring hospital admission, increase in more than 2 points in MELD score ⬎ 18 points, need for emergent orthotopic liver transplant and/or death) within 6 months after the TIPS was studied. Results: Eighty patients—22 females and 58 males (ages 77– 31; mean 53 years)—were included in the study. Indications for elective TIPS were refractory ascites (n⫽59), recurrent variceal bleeding (n⫽15) and hepatic hydrothorax (n⫽6). MELD score ranged from 7–23 (mean 14) before, and 7– 43 (mean 18) after TIPS, respectively. Mean LV was 1543 cc (range 742–3671). Twenty-four patients (30%) developed severe HE, with 3 patients requiring TIPS reduction. OLT was performed in 18 patients; in 8 as a planned procedure and in 10 as a rescue for liver failure after TIPS. Fifteen (18.7%) patients died within 6 months. No associations were found when modeling LV in terms of death, HE or MELD score. However, mean LV was significantly smaller in patients that underwent OLT than those that did not undergo OLT after TIPS (1,319 vs 1608 cc, p⫽0.04). Furthermore, the LV of patients that required emergency OLT for liver failure after TIPS (n⫽10), was significantly decreased compared to patients that underwent elective
TIPS without a planned OLT (n⫽62) (1246 cc vs 1,608 cc, p⫽0.03). Conclusion: Overall, LV has no correlation with increase of MELD ⬎18 points, severe HE and/or death within 6 months after elective TIPS. However, those patients requiring OLT after TIPS, either as a planned procedure or as a rescue for liver failure after the procedure, have significantly smaller LV.
8:48 AM
Abstract No. 75
Transjugular intrahepatic portosystemic stent-shunt placement in liver-transplant recipients P.P. Goffette, O. Ciccarelli, E. Bonacorsi, J.P. Lerut; Interventional Radiology, Cliniques Universitaires St-Luc, Brussels, Belgium Purpose: To determine the feasibility, efficacy and safety of transjugular intrahepatic portosystemic stent-shunt (TIPSS) in liver transplant (LT) recipients. Materials and Methods: Between July 1995 and June 2010, 30 transplanted patients (mean age 53 years) with recurrent hepatitis B or C virus infection (n⫽15), secondary biliary cirrhosis due to chronic rejection (n⫽2), portal vein thrombosis (n⫽4), Budd-Chiari disease (n⫽2), small-for-size syndrome after LDLT (n⫽3), or other uncommon causes of recurrent portal hypertension on the graft(n⫽4) underwent TIPSS implantation. Indications for portal decompression include refractory ascites (n⫽18), hydrothorax (n⫽3), recurrent variceal bleeding (n⫽3), early portal vein occlusion (n⫽3), liver insufficiency after LDLT (n⫽2) and portal pressure reduction before surgical biliary repair (n⫽1). The median time interval from LT to TIPSS was 21 months (2– 61). Bare and covered stents were implanted in 13 and 17 patients, respectively. A portal targetting was needed in 3 patients. Results: TIPSS procedure succeeded in all patients. The mean portosystemic pressure gradient was reduced from 16.9 to 7.1 mmHg. (Near)-complete ascites remission was achieved in 72% of patients with ascites. All patients with hydrothorax or variceal bleeding did respond dramatically to TIPSS. One among the two patients with small-for-size syndrome improved significantly. 18 patients (60%) developped new onset or worsening encephalopathy at a median of 21 days post TIPSS and 2 among them needed reducer device implantation. 17 of the 30 patients (57%) died during the study period, mainly from liver failure or sepsis. Four of five patients who underwent retransplantation survived. The median survival after TIPSS was 6.2 months (1.5–72). Conclusion: TIPSS indications may be extended to liver transplant recipients. Control of ascites or bleeding could be achieved in most cases. A poor survival rate due to liver failure or immunosupression-related sepsis is observed. Redo transplantation within 5 months after TIPSS placement could improve survival.
9:00 AM
Abstract No. 76
The effect of balloon-occluded retrograde transvenous obliteration (BRTO) on the model for end stage liver disease (MELD) score W. Saad1, W.M. Darwish1, C.L. Anderson1, S.S. Sabri1, M.G. Davies2, J.F. Angle1, U.C. Turba1, S.H. Caldwell3,
S34 䡲 Monday
Scientific Sessions 䡲 JVIR
Purpose: To determine what clinical, laboratory, or procedural variables predict the need for TIPS revisions in individuals with PTFE-covered TIPS. Materials and Methods: Between 2003–2009, a total of 141 patients underwent TIPS venographic evaluation following TIPS placement with PTFE-covered stents. Of these, a total of 43 patients required TIPS revisions. Twenty-three (23) different variables were modeled using univariate analysis, and then evaluated using a Cox proportional hazards model. Results: Of the variables tested, only the presence of a previous intervention predicted the need for further interventions (p⫽0.03). This variable also had an interaction with time (e.g. the hazard ratio increased over time), so that there was a greater likelihood of a need for a second revision as the time from the previous intervention increased. Other variables, including the size of the stent, etiology of portal hypertension, post-TIPS portosystemic gradient, and intrahepatic stent location failed to predict the need for future interventions. Conclusion: Individuals requiring one TIPS reinterventions should be aggressively screened for TIPS failures because of the increased likelihood that they will require another intervention. No correlation with other clinical, laboratory, or procedural variables was noted with the need for TIPS revisions.
8:36 AM
Abstract No. 74
Effect of liver volume in morbidity and mortality after elective TIPS J. Lopera1, K. Speeg2, D. Garg1, R. Suri1, G. Kroma1, F. Rivera1, W. Castaneda1; 1Radiology, UT Health Science Center, San Antonio, TX; 2Hepatology, UT Health Science Center, San Antonio, TX Purpose: To study the effect of liver volume (LV) in the morbidity and mortality after elective TIPS. Materials and Methods: A retrospective review was performed in patients admitted for elective TIPS in a single tertiary transplant center between 2003 and 2009. LV was measured in CT or MRI scans performed 1–3 months before the procedure. A possible correlation between LV and major adverse events (Hepatic Encephalopathy requiring hospital admission, increase in more than 2 points in MELD score ⬎ 18 points, need for emergent orthotopic liver transplant and/or death) within 6 months after the TIPS was studied. Results: Eighty patients—22 females and 58 males (ages 77– 31; mean 53 years)—were included in the study. Indications for elective TIPS were refractory ascites (n⫽59), recurrent variceal bleeding (n⫽15) and hepatic hydrothorax (n⫽6). MELD score ranged from 7–23 (mean 14) before, and 7– 43 (mean 18) after TIPS, respectively. Mean LV was 1543 cc (range 742–3671). Twenty-four patients (30%) developed severe HE, with 3 patients requiring TIPS reduction. OLT was performed in 18 patients; in 8 as a planned procedure and in 10 as a rescue for liver failure after TIPS. Fifteen (18.7%) patients died within 6 months. No associations were found when modeling LV in terms of death, HE or MELD score. However, mean LV was significantly smaller in patients that underwent OLT than those that did not undergo OLT after TIPS (1,319 vs 1608 cc, p⫽0.04). Furthermore, the LV of patients that required emergency OLT for liver failure after TIPS (n⫽10), was significantly decreased compared to patients that underwent elective
TIPS without a planned OLT (n⫽62) (1246 cc vs 1,608 cc, p⫽0.03). Conclusion: Overall, LV has no correlation with increase of MELD ⬎18 points, severe HE and/or death within 6 months after elective TIPS. However, those patients requiring OLT after TIPS, either as a planned procedure or as a rescue for liver failure after the procedure, have significantly smaller LV.
8:48 AM
Abstract No. 75
Transjugular intrahepatic portosystemic stent-shunt placement in liver-transplant recipients P.P. Goffette, O. Ciccarelli, E. Bonacorsi, J.P. Lerut; Interventional Radiology, Cliniques Universitaires St-Luc, Brussels, Belgium Purpose: To determine the feasibility, efficacy and safety of transjugular intrahepatic portosystemic stent-shunt (TIPSS) in liver transplant (LT) recipients. Materials and Methods: Between July 1995 and June 2010, 30 transplanted patients (mean age 53 years) with recurrent hepatitis B or C virus infection (n⫽15), secondary biliary cirrhosis due to chronic rejection (n⫽2), portal vein thrombosis (n⫽4), Budd-Chiari disease (n⫽2), small-for-size syndrome after LDLT (n⫽3), or other uncommon causes of recurrent portal hypertension on the graft(n⫽4) underwent TIPSS implantation. Indications for portal decompression include refractory ascites (n⫽18), hydrothorax (n⫽3), recurrent variceal bleeding (n⫽3), early portal vein occlusion (n⫽3), liver insufficiency after LDLT (n⫽2) and portal pressure reduction before surgical biliary repair (n⫽1). The median time interval from LT to TIPSS was 21 months (2– 61). Bare and covered stents were implanted in 13 and 17 patients, respectively. A portal targetting was needed in 3 patients. Results: TIPSS procedure succeeded in all patients. The mean portosystemic pressure gradient was reduced from 16.9 to 7.1 mmHg. (Near)-complete ascites remission was achieved in 72% of patients with ascites. All patients with hydrothorax or variceal bleeding did respond dramatically to TIPSS. One among the two patients with small-for-size syndrome improved significantly. 18 patients (60%) developped new onset or worsening encephalopathy at a median of 21 days post TIPSS and 2 among them needed reducer device implantation. 17 of the 30 patients (57%) died during the study period, mainly from liver failure or sepsis. Four of five patients who underwent retransplantation survived. The median survival after TIPSS was 6.2 months (1.5–72). Conclusion: TIPSS indications may be extended to liver transplant recipients. Control of ascites or bleeding could be achieved in most cases. A poor survival rate due to liver failure or immunosupression-related sepsis is observed. Redo transplantation within 5 months after TIPSS placement could improve survival.
9:00 AM
Abstract No. 76
The effect of balloon-occluded retrograde transvenous obliteration (BRTO) on the model for end stage liver disease (MELD) score W. Saad1, W.M. Darwish1, C.L. Anderson1, S.S. Sabri1, M.G. Davies2, J.F. Angle1, U.C. Turba1, S.H. Caldwell3,