Effect of time to pre-emptive transjugular intrahepatic portosystemic shunt on patient outcome, a UK multicentre cohort study

Philip Dunne*, Jemima Finkel, Faisal Khan, Neil Lachlan, David Patch, Dhiraj Tripathi, Adrian J Stanley, Peter Clive Hayes

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

Background & Aims
Pre-emptive transjugular intrahepatic portosystemic shunt (pTIPSS) should be considered within 72hrs following acute oesophageal variceal bleeding. However, recent studies highlight the difficulty in providing pTIPSS within this narrow timeframe. Delaying pTIPSS beyond 72hrs has not been studied.
Approach
Patients referred to 4 UK tertiary centres for pTIPSS between 01/01/2010 – 31/12/2018 were included. Time from endoscopy to pTIPSS was recorded and pre-defined clinically relevant outcomes were observed relative to two groups: early pTIPSS (Results
83 patients received early pTIPSS and 88 received late pTIPSS. Baseline characteristics were similar with no requirement for propensity score matched analysis. There was no difference between early and late pTIPSS groups for patient outcomes; 1-year transplant free survival rate (69.9% vs. 71.6%, p=0.73, HR 0.91, 95% CI 0.52-1.58), long-term survival (p=0.52, HR 1.132, 95% CI 0.77 – 1.65), variceal rebleeding (4.82% vs 11.36%, p=0.09, HR 0.411, 95% CI 0.14-1.17), hepatic encephalopathy (43.93% vs 34.61%, p=0.26), and new or worsening ascites (16.6% vs 13.46%, p=0.79). Death due to liver failure were significantly more prevalent in those undergoing early pTIPSS compared to late pTIPSS (44% vs 16%, p=0.046, HR 2.79, 95%CI 1.02-8.32).
Conclusion
Placement of pTIPSS within 72hrs offered similar short and long-term survival benefit compared to pTIPSS placed between 72hrs – 28 days. Early pTIPSS may be associated with increased risk of liver failure related mortality. Further large, randomised studies are required to evaluate these findings.
Original languageEnglish
JournalAlimentary Pharmacology and Therapeutics
Early online date18 Oct 2022
DOIs
Publication statusE-pub ahead of print - 18 Oct 2022

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