Covered Transjugular Intrahepatic Portosystemic Shunt improves survival for variceal Bleeding in cirrhotic patients with hepatic venous pressure gradient≥16 mmHg: A a comparison study

Abstract

AbstractObjectives:TIPS can decrease rebleeding in cirrhotic patients with variceal bleeding (VB), but it is controversial whether TIPS can improve survival. We aimed to assess whether TIPS improves survival in selected patients based on HVPG-related risk stratification in a long-term follow-up.Methods:Consecutive VB patients treated with endoscopic therapy+NSBBs or covered TIPS were retrospectively enrolled between January 2013 and December 2019. All patients had HVPG measurements by experienced personnel before therapy. Outpatient follow-up was performed regularly. The primary outcome was transplant-free survival. The secondary endpoints were rebleeding and OHE. Statistical analysis were performed.Results:According to the inclusion and exclusion criteria, 184 patients were analyzed (Mean age 55.27years ± 13.86, 107 males; 102 endoscopic therapy+NSBBs, 82 covered TIPS). Based on the HVPG-guided risk stratification, 70 patients had HVPGs lower than 16 mmHg, and 114 patients had HVPGs higher than 16 mmHg. The median follow-up time was 49.5 months. In the total cohort, the difference between the 2 therapies in terms of transplant-free survival was not statistically significant in the TIPS group (hazard ratio 0.6092, 95% CI 0.3546-1.046; p=0.0725). In the high-HVPG tier, transplant-free survival was higher in the TIPS group (hazard ratio 0.4385, 95% CI 0.2255-0.8525; p=0.0037). In the low-HVPG tier, transplant-free survival between the 2 treatments was similar without statistical significance (hazard ratio 0.8583, 95% CI 0.3301-0.232; p=0.7399). The difference in OHE between the two treatment groups was not statistically significant (P=0.0850; P=0.4791).Conclusions:TIPS can effectively improve transplant-free survival when HVPG is greater than 16 mmHg.