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Transjugular intrahepatic portosystemic shunt in patients with autoimmune hepatitis-induced cirrhosis and variceal bleeding

  • Interventional Radiology
  • Published:
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Abstract

Background and Aim

An increasing number of patients with autoimmune hepatitis (AIH)-induced cirrhosis and variceal bleeding are currently referred for transjugular intrahepatic portosystemic shunt (TIPS). The aim of this study was to evaluate the safety and efficacy of TIPS in such patients, and to compare these results with data from patients with hepatitis B virus (HBV)-induced cirrhosis.

Materials and Methods

This retrospective study consisted of 211 patients between August 2016 and May 2021, and patients were allocated to AIH (n = 35) and HBV (n = 176) groups according to the etiology of the cirrhosis. The primary endpoint was mortality after TIPS use; the secondary endpoints were recurrent bleeding, overt hepatic encephalopathy (OHE), shunt dysfunction, and dynamic changes in liver function over time.

Results

During a median follow-up period of 27 months, 23 (10.9%) patients died, 22 (10.4%) experienced recurrent bleeding, 50 (23.7%) experienced OHE, and 25 (11.8%) developed shunt dysfunction. Compared with the HBV group, the AIH group exhibited a similar mortality risk (adjusted hazard ratio, HR 1.199; 95% confidence interval, CI 0.367–3.917; p = 0.764), OHE (adjusted HR 1.023, 95% CI 0.483–2.167, p = 0.954), and shunt dysfunction (adjusted HR 0.862, 95% CI 0.285–2.610, p = 0.792); but a higher risk of recurrent bleeding (adjusted HR 2.731, 95% CI 1.112–6.708, p = 0.028). The dynamic changes in liver function manifested an initial trend toward deterioration, and then subsequent recovery in both the AIH and HBV groups.

Conclusions

TIPS is a safe and effective treatment, and should be considered for those patients with AIH-induced cirrhosis and variceal bleeding.

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Funding

Medical Science and Technology Project of Henan Province (LHGJ20190562), National Natural Science Foundation of China (81873917).

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Author notes

  1. Chaoyang Wang, Jiacheng Liu and **ghong Yao have contributed equally to this paper.

Authors and Affiliations

  1. Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan, 430022, China

    Chaoyang Wang, Jiacheng Liu, Shuguang Ju, Yingliang Wang, Chongtu Yang, Yaowei Bai, Wei Yao, Tongqiang Li, Yang Chen, Songjiang Huang & Bin **ong

  2. Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China

    Chaoyang Wang, Jiacheng Liu, Shuguang Ju, Yingliang Wang, Chongtu Yang, Yaowei Bai, Wei Yao, Tongqiang Li, Yang Chen, Songjiang Huang & Bin **ong

  3. Department of Infectious Disease, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China

    **ghong Yao

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  1. Chaoyang Wang
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Contributions

Conceptualization: BX; Methodology: CW and JL; Data collection: JY, SJ and YW; Data analysis and interpretation: CY; Software: CY and YB; Writing original draft: CW and WY; Writing review and editing: YC and SH.

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Correspondence to Bin **ong.

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Wang, C., Liu, J., Yao, J. et al. Transjugular intrahepatic portosystemic shunt in patients with autoimmune hepatitis-induced cirrhosis and variceal bleeding. Abdom Radiol 47, 1464–1472 (2022). https://doi.org/10.1007/s00261-022-03465-w

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  • DOI: https://doi.org/10.1007/s00261-022-03465-w

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