Mortality after transjugular intrahepatic portosystemic shunt in older adult cirrhotic patients: a validated prediction model

none34Implantation of a transjugular intrahepatic portosystemic shunt (TIPS) improves survival in cirrhotic patients with refractory ascites and portal hypertensive bleeding. However, the indication for TIPS in older adult patients (≥70 years) is debated and a specific prediction model developed in this particular setting is lacking. The aim of this study was to develop and validate a multivariable model for an accurate prediction of mortality in older adults.Vizzutti, Francesco; Celsa, Ciro; Calvaruso, Vincenza; Enea, Marco; Battaglia, Salvatore; Turco, Laura; Senzolo, Marco; Nardelli, Silvia; Miraglia, Roberto; Roccarina, Davide; Campani, Claudia; Saltini, Dario; Caporali, Cristian; Indulti, Federica; Gitto, Stefano; Zanetto, Alberto; Di Maria, Gabriele; Bianchini, Marcello; Pecchini, Maddalena; Aspite, Silvia; Di Bonaventura, Chiara; Citone, Michele; Guasconi, Tomas; Di Benedetto, Fabrizio; Arena, Umberto; Fanelli, Fabrizio; Maruzzelli, Luigi; Riggio, Oliviero; Burra, Patrizia; Colecchia, Antonio; Villa, Erica; Marra, Fabio; Cammà, Calogero; Schepis, FilippoVizzutti, Francesco; Celsa, Ciro; Calvaruso, Vincenza; Enea, Marco; Battaglia, Salvatore; Turco, Laura; Senzolo, Marco; Nardelli, Silvia; Miraglia, Roberto; Roccarina, Davide; Campani, Claudia; Saltini, Dario; Caporali, Cristian; Indulti, Federica; Gitto, Stefano; Zanetto, Alberto; Di Maria, Gabriele; Bianchini, Marcello; Pecchini, Maddalena; Aspite, Silvia; Di Bonaventura, Chiara; Citone, Michele; Guasconi, Tomas; Di Benedetto, Fabrizio; Arena, Umberto; Fanelli, Fabrizio; Maruzzelli, Luigi; Riggio, Oliviero; Burra, Patrizia; Colecchia, Antonio; Villa, Erica; Marra, Fabio; Cammà, Calogero; Schepis, Filipp

Liver Transplantation for Porto-Sinusoidal Vascular Liver Disorder: Long-term Outcome.

BACKGROUND AND AIMS Porto-sinusoidal vascular liver disorder (PSVD) is a rare disease that occasionally requires liver transplantation (LT), despite usually presenting preserved liver function. There remains a paucity of data pertaining to LT in PSVD. The aim was to identify features associated with post-LT outcomes in PSVD. METHODS Retrospective multicentre study of 79 patients who received LT for PSVD. RESULTS Median post-LT follow-up was 37 (range 1-261) mo. Refractory ascites 24 (30%), hepatic encephalopathy 16 (20%), and hepatopulmonary syndrome 13 (16.3%) were the most frequent indications for LT. Hepatocellular carcinoma was the indication in only 2 patients. Twenty-four patients died, 7 due to liver and 17 to non-liver related causes. Post-LT survival was 82.2%, 80.7%, and 68.6% at 1, 2, and 5 y, respectively. Post-LT survival was significantly better in patients without (n = 58) than in those with a persistent severe PSVD-associated condition (n = 21). Pre-LT hyperbilirubinemia levels and creatinine >100 µmol/L were also independently associated with poor survival. Six patients (7.6%) required a second LT. Recurrence of PSVD was confirmed by liver biopsy in only 1 patient and in 3 further patients it was likely. CONCLUSIONS LT in PSVD is associated with an acceptable outcome in the absence of associated severe conditions. However, persistence of a severe associated condition, pre-LT high bilirubin levels, or creatinine >100 µmol/L impact outcome, and these are features that should be considered when evaluating PSVD patients for LT. PSVD recurrence is possible after LT and needs to be explored, at least, in cases of posttransplant portal hypertension